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1.
BACKGROUND AND OBJECTIVES: Risk-taking behaviors differ among women and men injection drug users (IDU). GOAL: To specify the nature of sexual and drug risk-taking among women IDU and ex-IDU and how it relates to partner characteristics. DESIGN: A cross-sectional analysis of 324 HIV+ subjects enrolled into a prospective cohort study in Marseille, France. RESULTS: Women, as compared with men, were considerably more likely to report nonuse of condoms with a main partner (31% versus 12%). They were more likely to shoot with a partner at last injection (39% versus 12%), but far less likely to sterilize used needles (4% versus 16%). Two thirds of both men and women reported consistent condom use with a seronegative partner, but only 47% of men and 23% of women reported the same with a seropositive partner. Among the women only, needle and syringe sharing was associated with consistent use of a condom. CONCLUSIONS: Women reported behaviors which protect their partners from STD infection more frequently than behaviors which protect themselves. Greater attention must be paid to sexual risk-taking among HIV+ women.  相似文献   

2.
This study compared a sample of low-income African American women in the southeastern United States who had and had not yet undergone HIV counseling and testing on risk-related cognitive mediating variables and self-reported sexual behaviors. Four hundred sixty (N = 460) African American women were recruited from health clinics and community settings in a southern city. Forty-five percent of the women (n = 207) had undergone HIV counseling and testing, whereas 55% (n = 253) had never been tested. Women who were seropositive were excluded from the analyses. After providing informed consent, the women completed a battery of cognitive mediating measures assessing AIDS knowledge, attitudes theoretically relevant to risk reduction, and self-reported sexual behavior. In addition, each participant demonstrated condom application skills using a penile model. Women who had undergone testing were younger, rated HIV disease as more serious, considered AIDS a greater health concern, had more positive attitudes toward HIV prevention, expressed greater intentions to use condoms, and evidenced a greater commitment to self-protective behavior than women who were not yet tested. Women who had undergone HIV antibody testing, however, showed no differences in sexual behavior from women who were never tested. Sexual behavior, including numbers of partners, frequency of unprotected intercourse, and inconsistent condom use, left women in both groups at significant and comparable risk for HIV and sexually transmitted disease infection. HIV counseling and testing alone may not be effective primary prevention strategies for promoting risk reduction among African American women.  相似文献   

3.
OBJECTIVES: To confirm the risk factors for genital human papillomavirus (HPV) infection. GOAL OF THIS STUDY: To investigate risk factors for HPV detection apart from the correlated risk factors for cervical neoplasia. STUDY DESIGN: Cervical human papillomavirus (HPV) DNA was assessed in 357 cytologically normal women attending the University of New Mexico student health center. Cervical swab samples were obtained for HPV DNA detection and typing using a PCR-based DNA amplification system. Possible determinants of cervical HPV were examined including age, ethnicity, history of sexually transmitted disease, oral contraceptive use, smoking, age at first intercourse, lifetime number of sex partners, marital status, and history of pregnancy. RESULTS: A 44.3% overall prevalence of cervical HPV was observed. On univariate analysis, factors associated with increasing HPV prevalence included higher lifetime number of sex partners and single marital status. After adjustment for potential confounding variables, we found that HPV prevalence increased with higher lifetime number of sexual partners. CONCLUSION: These findings, along with those from the companion reports in this issue of the journal, support the sexual route of transmission of the virus.  相似文献   

4.
The female condom was developed in the 1980s. It is a contraceptive device used by women that protects against both pregnancy and sexually-transmitted diseases (STDs) including HIV infection. Two studies have investigated the contraceptive effectiveness of the female condom, and it was found to be as effective as other barrier methods. It has been shown to be effective against STD and HIV transmission in vitro but there is only limited evidence of its efficacy in vivo. No serious local side effects or allergies have been reported and the female condom can be used with any type of lubricant, spermicidal cream or foam. The female condom is the only device other than the male condom that has been shown to prevent HIV transmission. The female condom has been marketed in 13 countries since the summer of 1996. Most of these countries are industrialized and the selling price in these countries is too high for developing countries. Sub-Saharan Africa has very high prevalence rates for HIV infection, at least 30% of the general population in Eastern and Central regions. The epidemic is also spreading fast in some parts of the Western region. In Ivory Coast for example, 12 to 15% of pregnant women are infected. African women are subordinate to men in many aspects of their lives, politically, educationally, socially and sexually. This sexual inequality makes them highly vulnerable to STDs, including HIV, and unwanted pregnancies. This paper reviews 10 of the 15 studies carried out in sub-Saharan African countries between 1990 and 1996 and compiled by the World Health Organization. Recruitment methods, education of subjects, methodology and assessment of acceptability differed between studies. Despite these limitations, most studies concluded that the women who participated in the trials generally found the female condom acceptable. Acceptability was established quicker among prostitutes than among other women and men found the female condom less acceptable than did women. However, the sample size is too small to draw any firm conclusions. Commercial sex workers in the studies reviewed were very interested in this new method because it gave them an additional method of safer protection during sex. However, they were occasionally faced with difficult negotiations with some clients, refusal to use the female condom and sexual violence. Reuse of the device was reported in four studies, but the term reuse is seldom defined. In cases where it was defined, the frequency of reuse, with washing of the device, accounted for no more than 1% of the total number of uses. The acceptability of the female condom among women other than prostitutes faces two obstacles, the reaction of the woman's regular partner and attitudes to the device itself (appearance, difficulties or uneasiness concerning its use). However, some women liked it because it provided dual protection against pregnancy and STDs and sexual pleasure. The moderate level of acceptability to male partners may be overestimated because women whose partners disliked the device would be more likely to discontinue its use. The studies of acceptability reviewed here show that use of the female condom in Africa is realistic and that it provides women with more independent protection. Initial negative perceptions of the device are often replaced with a more positive reaction after several uses. The experience gained with use reduces the technical problems. We need to overcome the stereotypes, simplifications and strong opinions that threaten to damage the acceptance of this new method and efforts to encourage women to adopt it. However, we still require further clinical data on the effectiveness of the female condom at preventing pregnancy and HIV transmission. Availability of the female condom is improving in Africa. Pilot marketing studies were launched in 1996 in Guinea, Zambia, South Africa, followed by Uganda and Tanzania. There are local initiatives in Ivory Coast and Zimbabwe. (ABSTRACT TRUNC  相似文献   

5.
The question of whether personality traits or the relationship among marital partners is more significant for the importance of sexuality and satisfaction in sexual interaction was examined. It was demonstrated that only interaction variables were significant, satisfying sexual relationships existing only in happy marriages. Correspondence between the partners was quite good for "satisfaction in sexual interaction," but there was no correlation for the importance sexuality had for both partners. The comparison between the two sexes additionally showed that for women sexuality was less important and satisfying compared to men. This relationship held during various stages of the marital relationship.  相似文献   

6.
OBJECTIVE: To assess the risk of borderline ovarian cancer among infertile women treated with fertility drugs. DESIGN: Case-control study. SETTING: Nationwide data obtained from public registers and postal questionnaires. PATIENT(S): All Danish women <60 years old with borderline ovarian cancer during the period 1989-1994 and randomly selected population controls. The analysis included 231 cases and 1,721 controls. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Influence of parity, infertility, and fertility drugs on the risk of borderline ovarian cancer after multivariate confounder control. RESULT(S): The odds ratio (OR) for borderline ovarian cancer among infertile untreated nulliparous women compared with fertile nulliparous women was 1.9. The OR for borderline ovarian cancer among treated nulliparous women compared with untreated infertile nulliparous women was 1.5, and the OR among treated parous women compared with untreated infertile parous women was 1.5. CONCLUSION(S): Among fertile women, the difference in the risk of borderline ovarian cancer between nulliparous women and parous women was not statistically significant. Nulliparous women who were infertile and who did not receive medical treatment had a twofold higher risk of borderline ovarian cancer than fertile nulliparous women. There was no statistically significant increase in the risk of borderline ovarian cancer among nulliparous women who were treated with fertility drugs compared with nulliparous untreated infertile women or among parous women who were treated with fertility drugs compared with parous untreated infertile women.  相似文献   

7.
Thirty years of civil war in the Sudan have resulted in the isolation of the southern provinces which border Central and East Africa. Consequently, little is known about the epidemiology of HIV-1 infection in this region. To estimate the prevalence of HIV-1 infection in southern Sudan and the risk factors associated with disease transmission, a seroepidemiologic survey was conducted in the township of Juba. Study subjects invited to participate in this study included medical outpatients, inpatients hospitalized for active tuberculosis, and female prostitutes. A total of 401 subjects participated in the study. HIV-1 infection was confirmed in 25 subjects. The prevalence of HIV-1 infection was 19% (8/42) among tuberculosis patients, 16% (8/50) among prostitutes, and 3% (9/309) among outpatients. A significantly higher prevalence of HIV-1 infection was found among female prostitutes when compared to female outpatients: 16% (8/50) vs. 2% (4/178), P < 0.001. Correspondingly, the prevalence of seropositives was significantly higher among male outpatients reporting a history of sexual relations with prostitutes during the prior 10 years compared to male outpatients denying relations with prostitutes: 14% (5/37) vs. 0% (0/94), P = 0.0011. A history of a sexually transmitted disease (STD) was also associated with HIV-1 infection among male outpatients. The findings of this study indicate that HIV-1 infection is highly prevalent in southern Sudan and that prostitutes and their sexual partners represent a major reservoir of HIV infection in this population. This epidemiologic pattern resembles that seen in the African nations neighboring southern Sudan.(ABSTRACT TRUNCATED AT 250 WORDS)  相似文献   

8.
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.  相似文献   

9.
Women who were partners of HIV-positive blood donors were enrolled in a study of heterosexual HIV transmission between March 1992 and December 1996 and were interviewed and examined. Gynaecological conditions, including cervical dysplasia, human papillomavirus (HPV) infection, gonorrhoea, chlamydial infection, trichomoniasis, bacterial vaginosis, vaginal candidiasis and syphilis were assessed in addition to HIV status and CD4 level. Of 481 women enrolled, 224 (46.6%) were HIV seropositive. HIV-infected women were more likely to have abnormal vaginal discharge on physical examination (OR=2.6, P <0.01), HPV infection with a high-risk type (OR=6.9, P <0.01), and cervical dysplasia (OR=5.3, P <0.01). The prevalence of other gynaecological conditions detected at the enrolment visit did not differ by HIV status. History of prior STD (OR=2.0, P <0.01) was more common among HIV-infected women. The median CD4 count was 400 cells/microl among HIV-infected women. The prevalence of abnormal vaginal discharge and bacterial vaginosis increased significantly with decreasing CD4 count. The prevalence of ectopy, vaginal candidiasis, and cervical dysplasia increased with decreasing CD4 count, but these trends were not significant. We conclude that HIV-infected Thai women appear to have increased prevalences of abnormal vaginal discharge, squamous intraepithelial lesions and self-reported history of STD.  相似文献   

10.
OBJECTIVE: To investigate why women who use crack cocaine are at increased risk of human immunodeficiency virus (HIV) infection. METHODS: One thousand one hundred fifty-two (99.7%) of 1155 consecutive prenatal patients attending a rural public health clinic were interviewed about drug use and sexual practices and tested for HIV infection and other sexually transmitted diseases. RESULTS: Fifty-one (4.7%) of 1096 pregnant women reported ever using crack cocaine, but only five (10%) of the crack cocaine users had ever injected drugs. Eighteen (35%) of the crack users were HIV infected compared with 22 (2%) of the 1045 women who reported never using crack (odds ratio 25, 95% confidence interval 12-52; P < .001). Crack users were more likely to have had a known HIV-infected sex partner, exchanged sex for money or drugs, and tested positive for syphilis than were non-crack users (for each comparison, P < .001). Before using crack, 18% of crack users had exchanged sex for money or drugs and 8% had averaged three or more sex partners per month; in contrast, after beginning to use crack, 76% of crack users exchanged sex for money or drugs and 63% averaged three or more sex partners per month (for both comparisons, P < .001). Crack users who were not HIV infected were more likely to have almost always used condoms and/or had fewer than three sex partners per month than were HIV-infected crack users (P < .01). CONCLUSION: Women who reported using crack cocaine were at an increased risk of HIV infection because crack use was associated with a significant increase in unprotected sexual contact.  相似文献   

11.
OBJECTIVES: To investigate the magnitude and the time course of the HIV epidemic in the provinces of South Africa from the antenatal clinic HIV surveys. DESIGN: We analysed the data on the provincial prevalences of HIV infection from 1990 to 1996 using maximum likelihood methods to determine the intrinsic growth rate and probable asymptotic prevalence of HIV among women attending antenatal clinics. SUBJECTS: Women attending antenatal clinics and included in the national HIV prevalence surveys conducted by the Department of Health. RESULTS: 1. In KwaZulu-Natal the epidemic is likely to peak at a prevalence of about 23% (95% confidence interval (CI) 19-36%). 2. The intrinsic doubling time does not differ significantly among the provinces. 3. The average length of the intrinsic doubling time is 12.0 months (95% CI 11.3-12.8 months). 4. The force of infection is approximately 1.00/year at age 16 years and declines at a rate of about 5% per year of age above 16 years. CONCLUSIONS: South Africa is likely to experience one of the worst HIV epidemics in Africa. The lack of statistically significant differences between the growth rates of the epidemic in the various provinces constrains the possible explanations that can be advanced to explain the time course of the epidemic and may in part be a consequence of migrancy. The intrinsic growth rate is higher than previous estimates and it is possible that in those provinces where the prevalence is still low it will eventually reach the same levels as in KwaZulu-Natal.  相似文献   

12.
As the epidemic of the acquired immunodeficiency syndrome (AIDS) in sub-Saharan Africa enters its second decade, much has been learned about the distribution and determinants of the disease and its causative agent, the human immunodeficiency virus (HIV). Over 6 million people, or 2.5% of the adult population, are thought to be infected with HIV. The distribution of HIV is largely determined by sexual behavior; as for other sexually transmitted diseases, the characteristics of sexual networks determine the extent and rate of spread of HIV. Female sex workers and their male clients are at high risk for HIV and have been important in initiating the epidemic in many African countries. The dynamics of HIV in the rest of the population are complex; men with multiple sexual partners are largely responsible for transmission of HIV to women in the general population. Other sexually transmitted diseases and lack of male circumcision may increase the probability of transmission of HIV during sexual intercourse and probably are partially responsible for the rapid diffusion of HIV in Africa. Interventions among high-risk groups are needed, but they must be accompanied by attempts to induce behavior change among men and women in the general population. Epidemiologic studies of the determinants of sexual behavior and sexual contact patterns, as well the design and evaluation of interventions, are urgently needed. Key areas for development are the study of behavioral exposures and outcomes, the evaluation of interventions, developing new methods for conducting interventions in resource-poor environments, and increasing the number of African scientists with the skills and resources to conduct epidemiologic studies.  相似文献   

13.
This paper is based on the analyses of data collected in the Tanzania Demographic and Health Survey (TDHS). The TDHS national sample was obtained by using 1988 population census list of enumeration areas. Information about sexual behaviour and condom use was obtained from sexually active women (N = 4620) and men (N = 1440) reporting sexual activity during the period of four weeks preceding the survey. Univariate and multivariate (using logistic regression model) analyses were done to identify predictors of condom use and highrisk sexual behaviour. About 6% of women and 31% of men reported to have more than one sexual partner during the study period. Compared to respondents married once and in monogamous union, the tendency to have multiple partners was increased among never married women [OR 10.9, 95% CI (7.1-16.9)] and men [2.6 (1 7-3.9)], formerly married women [11.5 (7.3-17.9)], and among men in monogamous marriage reporting more than one marriage [12.4 (8.3-18.4)]. Occupation, residence, ever use of contraceptives, and AIDS knowledge were not associated with history of multiple sexual partners. Only 134 (9.3%) men and 173 (3.7%) women reported to have used condoms during the study period. After adjusting for other predictors of condom use, respondents reporting multiple sexual partners were more likely to have used condom among both women [3.4 (2.2-5.4)] and men [3.3 (2.3-6.0)]. Condom use was common in urban areas than rural areas and among unmarried respondents. These results show that high-risk sexual behaviour is common among men. Condom use was very low indicating that efforts to promote condom use has been less successful in Tanzania. More efforts are needed to promote safer sexual practices and condom use in Tanzania.  相似文献   

14.
This study examined the prevalence and predictors of HIV risk behaviors among a sample of 875 low-income, African American women residents of inner-city housing developments. The women completed an anonymous questionnaire that revealed that one third of them were at high risk for HIV either because they had multiple partners or because of the high-risk behaviors of their regular partner. HIV risk was highest among women who accurately perceived themselves to be at increased HIV risk, reported weak behavioral intentions to reduce risk, and held stronger beliefs about psychosocial barriers to condom use. Women at high risk were also younger, reported higher rates of substance use, and indicated that their housing development lacked social cohesiveness. These findings suggest that HIV prevention efforts for this population should focus on strengthening women's risk reduction behavioral intentions and self-efficacy through skill development, overcoming psychosocial barriers to condom use, managing the risk related to substance use, and incorporating approaches that take into account the social, psychological, and relationship barriers to change among economically impoverished African American women.  相似文献   

15.
OBJECTIVE: To evaluate the luteal phase in women with rigorously defined unexplained infertility. DESIGN: Prospective study. SETTING: National Center for Infertility Research at Michigan. PATIENT(S): Evaluation of 1,885 women with infertility identified 12 women who met the rigorously defined criteria for unexplained infertility: [1] infertility of > or = 24 months duration, with no male factor, anatomic-functional disorders of the reproductive tract, or immunologic infertility; [2] normal body mass index (BMI); [3] ovulatory cycles ranging from 26 to 32 days; [4] normal luteal phase determined by endometrial biopsy; and [5] normal baseline hormonal profile. Controls (n = 12) were healthy, parous women with normal ovulatory cycles, normal hormonal screen, and were matched for age and BMI to patients. MAIN OUTCOME MEASURE(S): Pattern of follicular growth rate and luteal phase hormonal profile. RESULT(S): Women with unexplained infertility did not differ in menstrual cycle characteristics, follicular growth rate or mean preovulatory follicle diameter, or endometrial biopsy dating. The mean levels of P tended to be lower in the unexplained infertility group throughout the luteal phase, but only the midluteal interval reached statistical significance. Luteal phase mean integrated P or urinary PDG levels of unexplained infertility women did not differ from those of fertile controls. The ratio of integrated E2:P also was significantly greater in women with unexplained infertility than in fertile controls. CONCLUSION(S): Women with rigorously defined unexplained infertility have subtle hormonal anomalies during the luteal phase when compared with fertile controls.  相似文献   

16.
INTRODUCTION: This longitudinal study examined the prevalence and demographic correlates of unprotected insertive and receptive anal intercourse among HIV-positive gay and bisexual men who were aware of their serostatus. METHODS: Participants (n = 395), sampled randomly at two HIV outpatient clinics in Los Angeles, completed two waves of self-administered questionnaires (separated by approximately 7-9 months) that measured sexual behaviors in the previous 60 days. RESULTS: The cross-sectional prevalence of unprotected insertive anal intercourse was 11.2% at time 1 and 7.1% at time 2. Longitudinal analysis indicated that nearly 15% of the participants had engaged in that high-risk behavior either at time 1 or time 2 and approximately 4% had engaged in the behavior at each time period. Similar rates of unprotected receptive anal intercourse were observed. These high-risk activities were more prevalent with seropositive and unknown serostatus partners than with seronegative partners. The rate of anal intercourse risk behaviors was higher among asymptomatic men and among those who were exclusively gay. CONCLUSION: The findings demonstrate considerable differences in the prevalence of stable and occasional high-risk sexual behaviors among HIV-positive gay and bisexual men. Simple cross-sectional analyses cannot capture the stability or variation in behavior across time and, thus, may generate misleading conclusions about disease transmission, especially if the partner's HIV serostatus is not considered in the analysis. The findings indicate a need for focused safer-sex interventions for seropositive men. The HIV outpatient clinic is an ideal setting for such interventions.  相似文献   

17.
One obstacle to contain the HIV-1 epidemic in the general population in Africa is a lack of knowledge about how it is spread in rural areas. We examined 683 pregnant women in 1989 and 484 in 1993 who attended antenatal clinics in Lindi district, Tanzania to determine changes in the prevalence of HIV-1 in a remote area in East Africa. The prevalence rose from 0.44% in 1989 to 8.7% in 1993. Women with more than 1 partner (17.25% vs 2.78%), STD patients (42.4% vs 6.2%), women from urban areas (10.2% vs 3.57%) and patients younger than 21 years were more likely to have HIV antibodies. By logistic regression analysis, 1993 as year of testing was associated with the greatest risk for HIV seropositivity (P < 0.00002) followed by clinical signs of STD (P < 0.00005) and urban residence (P = 0.0275). Teaching of all women attending antenatal care how to minimize their future risk of acquiring HIV is urgently needed as one tool to prevent a fast spread of HIV throughout the continent.  相似文献   

18.
This pilot study was carried out in southwest Nigeria to determine the current trends in sexual behaviours known to be associated with HIV transmission in Nigeria. Knowledge of AIDS in general and as an incurable disease was high (91.4% and 79.4% respectively). Knowledge of the means of AIDS transmission was also very high among both men and women. Overall, condom use was consistent at 25%, inconsistent at 55% and non-existent at 20% for all sexually active respondents. Over 60 per cent of sexually active respondents had two or more sexual partners, with significantly more males than females having this number of sexual partners (p < 0.01). Eighteen per cent of sexually active respondents had a history of sex with commercial sex workers while 25% had a history of at least one sexually transmitted disease. Using multiple logistic regression, the significant determinants of condom use among the sexually active group were: being in a stable sexual relationship, history of sex with commercial sex workers, self-perception of testing positive for HIV and self-perception of HIV/AIDS risk in Nigeria. Prevalence of condom use in this study was much higher than those reported in previous studies, suggesting a probable decline in high risk sexual behaviours among inhabitants of urban Southwest Nigeria since the advent of AIDS. Most sexually active respondents aged 19 years or below (adolescents) who perceived themselves at a high risk of testing positive for HIV had never used condoms. The non usage of condoms among this group of adolescents is disturbing, since they are at greatest risk of spreading the disease. Health education and promotion of safe sex practices need to be extensively targeted at adolescents.  相似文献   

19.
Blacks comprise 55% of all AIDS cases among women, and have 9 times the risk of white women of mortality from AIDS. Thus, prevention of HIV infection is critical among black women. Programs to prevent HIV infection have focused upon the adoption of behavioral strategies such as limiting the number of sexual partners, avoiding intercourse with i.v. drug users, and using condoms. However, such programs are dependent upon the ability of the woman to assume responsibility for her health and successfully adopt behavior changes. Generally overlooked in the development of health education interventions are those factors, such as depressive symptoms, which may make it very difficult for an individual to adopt healthy behaviors. In the present study, an analysis was conducted of the association between depressive symptoms and risk factors for the acquisition of HIV infection among black women using two urban health centers. Those women with higher levels of depressive symptoms were significantly more likely than other women to report more risk factors for HIV acquisition. The implications of these findings for the development of preventive interventions are discussed.  相似文献   

20.
In 2 studies of physical violence and sexuality among college students, more than 75% of men and more than 60% of women reported committing physical violence in the past year, including more women to partners and more men to non-partners. More than 90% of men who committed violence to partners were also violent to non-partners. In Study 1, among 193 men and 203 women, people who committed violence had higher scores on sexual depression and general depression than did people who were not violent. People violent to non-partners had more sexual preoccupation and more alcohol use problems than did other people. In Study 2, among 160 college men and 138 college women, people in 4 violence groups did not differ in total sexual fantasies or sexual functioning. The findings support the importance of differentiating between violence toward partners and toward non-partners among both men and women and suggest a role of depression in partner violence and antisocial features in violence toward non-partners. (PsycINFO Database Record (c) 2010 APA, all rights reserved)  相似文献   

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