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Malli IA, Kabli BA, Alhakami LA. Sexually Transmitted Diseases among Saudi Women: Knowledge and Misconceptions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4858. [PMID: 36981767 PMCID: PMC10048940 DOI: 10.3390/ijerph20064858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
The rate of sexually transmitted diseases is increasing globally. Thus, this study aimed to examine the Al akami female community's knowledge about the nature of sexually transmitted diseases and their associated factors. The STDs-Knowledge Questionnaire (STDs-KQ) was utilized to collect data from the female community (355) in Jeddah, Saudi Arabia. The data were analyzed using JMP Statistics for Windows, version 15. The significance level was set at 0.05. The study reported that participants had a relatively low understanding of STDs in acquisition, protection, prevention, and clinical signs and symptoms; only 33 (9%) had high knowledge scores (10-18), while 70% thought one virus caused all forms of STDs. Also, only 15% of the respondents knew the clinical features of the Chlamydia infection, and 18% identified the correct mode of its transmission. Also, older participants with clinical exposure had a higher knowledge score than young and single females, p < 0.05. A positive correlation between age and knowledge score was reported, r (354) = 0.339, p < 0.0001. The low knowledge scores were associated with marital status, age, and clinical exposure. Practical strategies to minimize literacy toward sexual education and increase the quality of sexual life must be promoted by educators and the academic curriculum.
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Affiliation(s)
- Israa Abdullah Malli
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah 21423, Saudi Arabia
- Ministry of National Guard—Health Affairs, Jeddah 21423, Saudi Arabia
| | - Basmah Abdullah Kabli
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah 21423, Saudi Arabia
- Ministry of National Guard—Health Affairs, Jeddah 21423, Saudi Arabia
| | - Lujain Ali Alhakami
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah 21423, Saudi Arabia
- Ministry of National Guard—Health Affairs, Jeddah 21423, Saudi Arabia
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2
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Ruiz-Tagle Maturana JA, Cáceres DD, Castillo-Carniglia Á. Association between substance use and number of sexual partners: evidence from Chile. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2153755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- José Antonio Ruiz-Tagle Maturana
- Programa de Doctorado en Políticas Públicas, Universidad Mayor, Santiago, Chile
- Programa de Bioestadística, Escuela de Salud Pública, Universidad de Chile, Santiago, Chile
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Chile
| | - Dante D. Cáceres
- Environmental Health Program, Public Health School, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Health Sciences School, Universidad de Tarapacá, Arica, Chile
| | - Álvaro Castillo-Carniglia
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Chile
- Society and Health Research Center, Facultad de Ciencias Sociales y Artes, Universidad Mayor, Santiago, Chile
- Millennium Nucleus on Sociomedicine (SocioMed), Chile
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Hensel DJ, O’Sullivan LF. Sexual Concurrency Among Adolescent Women With Multiple Partners: A Daily Diary Study. J Adolesc Health 2022; 71:70-77. [PMID: 35354537 PMCID: PMC9232968 DOI: 10.1016/j.jadohealth.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Sexual partnerships that overlap in some period of time (i.e., concurrent) are a key factor in sexually transmitted infection (STI) transmission. Research examining concurrency among adolescents typically uses person-level, cross-sectional, and/or retrospective data, obscuring factors that manifest on any given occasion of concurrency. We used sexual diaries to examine: (1) daily prevalence of vaginal sex concurrency when two partners are reported by adolescent women; and (2) individual, relational, and behavioral attributes that impact the likelihood of sex with neither partner, with one partner or the other, or with both partners on any given day. METHODS Daily diaries were drawn from a large longitudinal cohort study examining sexual relationships, behaviors, and STIs among adolescent women. Participants contributed 280,844 partner-associated diary entries, of which (27.9%; n = 78,356) indicated multiple partners. All two-partner diary entries were retained for analysis (N = 323; Mage = 17.55; 90% African American). Random intercept mixed-effects multinomial logistic regression was used to evaluate the impact of predictor variables on odds of having sex with one or the other, both, or neither partner. RESULTS Most two-partner days (93.5%) involved no sex with either partner. Few reports (.2%) indicated same-day sexual concurrency. Older age, greater partner support, and higher sexual interest increased the likelihood of sex with both partners on the same day. CONCLUSIONS Individual, relational, and behavioral factors predict concurrency in ways that challenge assumptions that secondary partnerships constitute negligible relationships. Programs targeting partner concurrency in adolescents may find success tailoring messaging around these findings.
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Affiliation(s)
- Devon J. Hensel
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN,Department of Sociology, Indiana University Purdue University Indianapolis, Indianapolis, IN
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Siziba A, Nunu WN, Mudonhi N, Ndlovu V, Munyai O, Ndlovu B, Sanganyado E. Risk factors associated with a high incidence of sexually transmitted infections in Beitbridge, Zimbabwe. Curationis 2021. [DOI: 10.4102/curationis.v44i1.2191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Bauman LJ, Watnick D, Silver EJ, Rivera A, Sclafane JH, Rodgers CRR, Leu CS. Reducing HIV/STI Risk Among Adolescents Aged 12 to 14 Years: a Randomized Controlled Trial of Project Prepared. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:1023-1035. [PMID: 33606173 PMCID: PMC8541978 DOI: 10.1007/s11121-021-01203-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 11/01/2022]
Abstract
Despite calls for evidence-based HIV/STI prevention programs for youth aged 12 to 14 transitioning to adolescence, few effective programs exist. In a two-group intent-to-treat randomized trial in the Bronx, NY, 397 participants were randomly assigned to Project Prepared or an attention control, TEEN. Participants completed surveys at baseline, 6 months, and 12 months. Prepared had two components, an 11-session program and a 3-week internship. Content covered sexual risk behavior, social cognitions, gender norms, relationships, and resilience. TEEN built communication skills and had the same intensity and structure as Prepared but no sexual content. In both, boys and girls were trained together in mixed groups of ~ 11 teens. Primary outcomes were HIV knowledge, self-efficacy, condom outcome expectancy, and behavioral intentions. Secondary outcomes were relationship expectations and endorsement of risky gender norms. Generalized estimating equation analyses showed youth randomized to Prepared had significant improvements compared to TEEN at T2 in HIV knowledge, sexual self-efficacy, and outcome expectancy for condom use. At T3, there were significant differences favoring Prepared in outcome expectancy for condom use, sexual self-efficacy, and intention for partner communication about HIV/AIDS or STIs. Analyses by gender showed program effects in both boys (intention to talk to a partner about condom use, abstinence self-efficacy, sexual self-efficacy, and condom outcome expectancy) and girls (gender norms, and abstinence outcome expectancy). Prepared effectively reduced risk in young adolescents. ClinicalTrials.gov ID: NCT01880450, Protocol ID: 2008-551.
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Affiliation(s)
- Laurie J Bauman
- Preventive Intervention Research Center, Department of Pediatrics, Albert Einstein College of Medicine, 1300 Morris Park Avenue VE6B25, Bronx, NY, 10461, USA.
| | - Dana Watnick
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Angelic Rivera
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Caryn R R Rodgers
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Cheng-Shiun Leu
- Mailman School of Public Health, Columbia University, New York City, NY, USA
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The Influence of Emerging Adulthood on the Risky and Dangerous Behaviors of LGBT Populations. SOCIAL SCIENCES-BASEL 2020. [DOI: 10.3390/socsci9120228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
During emerging adulthood, traditional social bonds and turning points may be delayed, not present, or may not work in the same manner as they had for prior generations, leading many to engage in risky and dangerous behaviors. Lesbian, Gay, Bisexual and Transgendered emerging adults may be at particular risk for engaging in risky and dangerous behavior during emerging adulthood due to the lack of social bonds, reaching of turning points, as well as the historic stigmatization of these populations. Focusing on LGBT populations in the United States, the influence of emerging adulthood on risky and dangerous behaviors is presented; a theoretical examination of the relationship between LGBT populations and risky and dangerous behaviors is provided; the influence of emerging adulthood on LGBT populations is explored; research on the role of emerging adulthoods influence on the risky and dangerous behaviors of LGBT populations is presented; and theoretical and policy implications are offered.
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Tao X, Ghanem KG, Page KR, Gilliams E, Tuddenham S. Risk factors predictive of sexually transmitted infection diagnosis in young compared to older patients attending sexually transmitted diseases clinics. Int J STD AIDS 2020; 31:142-149. [PMID: 31964236 DOI: 10.1177/0956462419886772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Young people aged less than 25 years bear the highest burden of sexually transmitted infections (STIs) in the United States. Here we sought to characterize patients aged 15–24 compared with patients ≥age 25 utilizing a database of first visits to two STI clinics in Baltimore, USA from 2011 to 2016. Acute STI (aSTI) was defined as gonorrhea (GC), trichomonas, or early syphilis (ES) in women and non-gonococcal urethritis, GC, Chlamydia (CT), and ES in men. Proportions were compared using the Chi square test and logistic regression was used to assess aSTI predictors in younger versus older groups, stratified by gender. Fifteen thousand four hundred and sixty-three first visits for patients <25 and 25,203 for patients ≥25 were analyzed. Participants <25 were more likely to be Black and less likely to self-identify as straight than those ≥25. While younger patients had more partners, they were less likely to report risk behaviors such as ‘Never’ using condoms, cocaine use, and sex with alcohol than older patients. Predictors of aSTI risk differed both by age and gender. STI prevention messages should be tailored, and access to screening should be optimized for young men and women, in order to address rising STI rates in this population.
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Affiliation(s)
- Xueting Tao
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Khalil G Ghanem
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathleen R Page
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Baltimore City Health Department, Baltimore, MD, USA
| | | | - Susan Tuddenham
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Hogben M, Leichliter J, Aral SO. An Overview of Social and Behavioral Determinants of STI. Sex Transm Infect 2020. [DOI: 10.1007/978-3-030-02200-6_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Impact of Providing Preexposure Prophylaxis for Human Immunodeficiency Virus at Clinics for Sexually Transmitted Infections in Baltimore City: An Agent-based Model. Sex Transm Dis 2019; 45:791-797. [PMID: 29944642 DOI: 10.1097/olq.0000000000000882] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preexposure prophylaxis (PrEP) greatly reduces the risk of human immunodeficiency virus (HIV) acquisition, but its optimal delivery strategy remains uncertain. Clinics for sexually transmitted infections (STIs) can provide an efficient venue for PrEP delivery. METHODS To quantify the added value of STI clinic-based PrEP delivery, we used an agent-based simulation of HIV transmission among men who have sex with men (MSM). We simulated the impact of PrEP delivery through STI clinics compared with PrEP delivery in other community-based settings. Our primary outcome was the projected 20-year reduction in HIV incidence among MSM. RESULTS Assuming PrEP uptake and adherence of 60% each, evaluating STI clinic attendees and delivering PrEP to eligible MSM reduced HIV incidence by 16% [95% uncertainty range, 14%-18%] over 20 years, an impact that was 1.8 (1.7-2.0) times as great as that achieved by evaluating an equal number of MSM recruited from the community. Comparing strategies where an equal number of MSM received PrEP in each strategy (ie, evaluating more individuals for PrEP in the community-based strategy, because MSM attending STI clinics are more likely to be PrEP eligible), the reduction in HIV incidence under the STI clinic-based strategy was 1.3 (1.3-1.4) times as great as that of community-based delivery. CONCLUSIONS Delivering PrEP to MSM who attend STI clinics can improve efficiency and effectiveness. If high levels of adherence can be achieved in this population, STI clinics may be an important venue for PrEP implementation.
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Abstract
Leveraging 2.5 years of weekly data from the Relationship Dynamics and Social Life Study, we investigate the relationship between young women's sexual concurrency and their contraceptive behavior. Specifically, we (1) examine whether young women changed their contraceptive use when switching from one to multiple concurrent sexual partners in the same week; (2) explore the uniformity of contraceptive responses to concurrency across relationship context; and (3) compare the contraceptive behaviors of never-concurrent women with those of ever-concurrent women in weeks when they were not concurrent. Nearly one in five sexually active young women had sex with two or more people in the same week. When they were concurrent, these women's odds of using any contraception increased threefold, and their odds of using condoms increased fourfold. This pattern of contraceptive adjustments was the same across relationship characteristics, such as duration and exclusivity. Yet when they were not concurrent, ever-concurrent women were less likely to use any contraception and used condoms less consistently than women who were never concurrent. We discuss these findings in the context of ongoing debates about the role of sexual concurrency in STI transmission dynamics.
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Affiliation(s)
- Abigail Weitzman
- Population Research Center, University of Texas at Austin, 305 E. 23rd Street, RLP 2.602, Mail Stop G1800, Austin, TX, 78712-1699, USA.
- Department of Sociology, University of Texas at Austin, 305 E. 23rd Street, A1700, RLP 3.306, Austin, TX, 78712-1086, USA.
| | - Jennifer Barber
- Population Studies Center, University of Michigan, Ann Arbor, MI, USA
- Department of Sociology, University of Michigan, Ann Arbor, MI, USA
| | - Yasamin Kusunoki
- Population Studies Center, University of Michigan, Ann Arbor, MI, USA
- Department of Nursing, University of Michigan, Ann Arbor, MI, USA
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Nalukwago J, Alaii J, Borne BVD, Bukuluki PM, Crutzen R. Application of Core Processes for Understanding Multiple Concurrent Sexual Partnerships Among Adolescents in Uganda. Front Public Health 2018; 6:371. [PMID: 30622938 PMCID: PMC6308184 DOI: 10.3389/fpubh.2018.00371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/04/2018] [Indexed: 12/29/2022] Open
Abstract
Introduction: Adolescents in Uganda, as in other sub-Saharan countries, engage in sex with multiple concurrent partners, thus placing them at risk for HIV and unplanned pregnancies, but it is not clear why. This study explored why adolescents in Uganda engage in multiple concurrent sexual partnerships (MCSP). Methods: This study used a Core Processes methodology. We used the processes of brainstorming, and identification of evidence and theoretical support, in various phases/steps of intervention planning, to provide possible explanations for adolescent MCSP. Results: Adolescents were found to have limited knowledge of the risks associated with MCSP and perceived a low risk for HIV. Peer influence to engage in MCSP exacerbated the problem among adolescents. Poor communication with sexual partners and parents and societal indifference to multiple sexual partnerships increased permissive attitudes toward infidelity. The unclear adolescent sexual and reproductive health policies hampered access to services, and transactional sexual relationships with older (polygamous) sexual partners increased the HIV risk. Adolescents were found to be more concerned about unplanned pregnancies than HIV risk. Discussion: From the empirical evidence, adolescent health programs in Uganda should incorporate comprehensive sexual health education on HIV and teenage pregnancy risk-reduction strategies. Programs should strengthen parental and community support through enhanced collaborative training on communication with and for adolescents. Forming strategic partnerships with various stakeholders for concerted efforts to address the MCSP problem among adolescents is critical.
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Affiliation(s)
- Judith Nalukwago
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Family Health International 360 (Uganda), Kampala, Uganda
- Department of Social Work and Social Administration, Makerere University, Kampala, Uganda
| | - Jane Alaii
- Context Factor Solutions, Nairobi, Kenya
| | - Bart Van Den Borne
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Paul Mukisa Bukuluki
- Department of Social Work and Social Administration, Makerere University, Kampala, Uganda
| | - Rik Crutzen
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
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Decline in Herpes Simplex Virus Type 2 Among Non-Injecting Heroin and Cocaine Users in New York City, 2005 to 2014: Prospects for Avoiding a Resurgence of Human Immunodeficiency Virus. Sex Transm Dis 2017; 44:85-90. [PMID: 27898577 DOI: 10.1097/olq.0000000000000549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Herpes simplex virus type 2 (HSV-2) infection increases both susceptibility to and transmissibility of human immunodeficiency virus (HIV), and HSV-2 and HIV are often strongly associated in HIV epidemics. We assessed trends in HSV-2 prevalence among non-injecting drug users (NIDUs) when HIV prevalence declined from 16% to 8% among NIDUs in New York City. METHODS Subjects were current non-injecting users of heroin and/or cocaine and who had never injected illicit drugs. Three thousand one hundred fifty-seven NIDU subjects were recruited between 2005 and 2014 among persons entering Mount Sinai Beth Israel substance use treatment programs. Structured interviews, HIV, and HSV-2 testing were administered. Change over time was assessed by comparing 2005 to 2010 with 2011 to 2014 periods. Herpes simplex virus type 2 incidence was estimated among persons who participated in multiple years. RESULTS Herpes simplex virus type 2 prevalence was strongly associated with HIV prevalence (odds ratio, 3.9; 95% confidence interval, 2.9-5.1) from 2005 to 2014. Herpes simplex virus type 2 prevalence declined from 60% to 56% (P = 0.01). The percentage of NIDUs with neither HSV-2 nor HIV infection increased from 37% to 43%, (P < 0.001); the percentage with HSV-2/HIV coinfection declined from 13% to 6% (P < 0.001). Estimated HSV-2 incidence was 1 to 2/100 person-years at risk. CONCLUSIONS There were parallel declines in HIV and HSV-2 among NIDUs in New York City from 2005 to 2014. The increase in the percentage of NIDUs with neither HSV-2 nor HIV infection, the decrease in the percentage with HSV-2/HIV coinfection, and the low to moderate HSV-2 incidence suggest some population-level protection against resurgence of HIV. Prevention efforts should be strengthened to end the combined HIV/HSV-2 epidemic among NIDUs in New York City.
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Platteau T, van Lankveld J, Ooms L, Florence E. Sexual Behavior and Sexually Transmitted Infections Among Swingers: Results From an Online Survey in Belgium. JOURNAL OF SEX & MARITAL THERAPY 2017; 43:709-719. [PMID: 27902890 DOI: 10.1080/0092623x.2016.1263702] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Swingers are couples practicing consensual extradyadic heterosexual relations. This subculture is defined by venues and online communities. This study aimed to assess swingers' lifestyle, sexual health, and history of testing for sexually transmitted infections (STIs) and to review risk factors for sexual risk behavior and STI transmission. An online survey was distributed through venues, chat websites, and dating websites. Most of 480 swingers starting the survey completed it (n = 392, 81.6%). Women (n = 146) reported more frequent swinging (p = 0.013), same-sex contacts (p < 0.001), and more sex under influence of alcohol (p < 0.001). Men (n = 334) reported more anal sex (p = 0.002) and condomless vaginal sex (p = 0.004). Of respondents tested, 25.7% ever received an STI diagnosis. Using logistical regression, being male, older, single, and party drug use were associated with sexual risk behavior (p = 0.009). Higher frequency of swinging was associated with an STI diagnosis (p = 0.036). Swingers were sexually active, reported factors associated with sexual risk behavior, and were more diagnosed with an STI compared to the general population. Many swingers were tested for STIs. Nonetheless, implementation of tailored testing strategies should be considered given their elevated risk for STI acquisition.
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Affiliation(s)
- Tom Platteau
- a Department of Clinical Sciences , Institute of Tropical Medicine , Antwerp , Belgium
| | - Jacques van Lankveld
- b Psychology Department , Open University of the Netherlands , Heerlen , The Netherlands
| | - Lieselot Ooms
- a Department of Clinical Sciences , Institute of Tropical Medicine , Antwerp , Belgium
| | - Eric Florence
- a Department of Clinical Sciences , Institute of Tropical Medicine , Antwerp , Belgium
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Ashenhurst JR, Wilhite ER, Harden KP, Fromme K. Number of Sexual Partners and Relationship Status Are Associated With Unprotected Sex Across Emerging Adulthood. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:419-432. [PMID: 26940966 PMCID: PMC5806124 DOI: 10.1007/s10508-016-0692-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 12/13/2015] [Accepted: 01/04/2016] [Indexed: 05/12/2023]
Abstract
Sex with multiple partners, consecutively or concurrently, is a risk factor for contracting sexually transmitted infections (STIs) as multiple partner-partner contacts present increased opportunity for transmission. It is unclear, however, if individuals who tend to have more partners also use protection less reliably than those with sexual histories of fewer partners. Longitudinal data can elucidate whether an individual shows a consistent pattern of sex with multiple partners. We used latent class growth analyses to examine emerging adult survey data (N = 2244) spanning 10 waves of assessment across 6 years. We identified three trajectory classes described with respect to number of partners as (a) Multiple, (b) Single, and (c) Rare. Trajectory group, relationship status, and their interactions were tested as predictors of using protection against STIs and pregnancy at each wave. The Multiple Partners class had the greatest odds ratio of reporting sex without protection against STIs and pregnancy, followed by the Single and Rare classes. Exclusive relationship status was a risk factor for unprotected sex at earlier waves, but a protective factor at most later waves. There was no significant interaction between relationship status and trajectory class in predicting use of protection. The Multiple Partners class reported more permissive values on sex and an elevated proportion of homosexual behavior. This group overlaps with an already identified at-risk population, men who have sex with men. Potential mechanisms explaining the increased risk for sex without protection, including communication, risk assessment, and co-occurring risk behaviors are discussed as targets for intervention.
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Affiliation(s)
- James R Ashenhurst
- Department of Psychology, The University of Texas at Austin, 1 University Station, A8000, Austin, TX, 78712, USA.
| | - Emily R Wilhite
- Department of Psychology, The University of Texas at Austin, 1 University Station, A8000, Austin, TX, 78712, USA
| | - K Paige Harden
- Department of Psychology, The University of Texas at Austin, 1 University Station, A8000, Austin, TX, 78712, USA
| | - Kim Fromme
- Department of Psychology, The University of Texas at Austin, 1 University Station, A8000, Austin, TX, 78712, USA
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Hernandez I, Johnson A, Reina-Ortiz M, Rosas C, Sharma V, Teran S, Naik E, Salihu HM, Teran E, Izurieta R. Syphilis and HIV/Syphilis Co-infection Among Men Who Have Sex With Men (MSM) in Ecuador. Am J Mens Health 2016; 11:823-833. [PMID: 27923971 PMCID: PMC5675307 DOI: 10.1177/1557988316680928] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
There is a reemergence of syphilis in the Latin American and Caribbean region. There is also very little information about HIV/Syphilis co-infection and its determinants. The aim of this study is to investigate knowledge, attitudes, and practices regarding sexually transmitted infections (STIs), in particular syphilis infection and HIV/Syphilis co-infection, as well as to estimate the prevalence of syphilis among men who have sex with men (MSM) in a city with one of the highest HIV prevalence rates in Ecuador. In this study, questionnaires were administered to 291 adult MSM. Questions included knowledge about STIs and their sexual practices. Blood samples were taken from participants to estimate the prevalence of syphilis and HIV/syphilis co-infection. In this population, the prevalence of HIV/syphilis co-infection was 4.8%, while the prevalence of syphilis as mono-infection was 6.5%. Participants who had syphilis mono-infection and HIV/syphilis co-infection were older. Men who had multiple partners and those who were forced to have sex had increased odds of syphilis and HIV/syphilis co-infection. A high prevalence of syphilis and self-reported STI was observed, which warrants targeted behavioral interventions. Co-infections are a cause for concern when treating a secondary infection in a person who is immunocompromised. These data suggest that specific knowledge, attitudes, and behaviors among MSM are associated with increased odds of STIs (including HIV/syphilis co-infections) in this region of Ecuador.
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Affiliation(s)
| | | | - Miguel Reina-Ortiz
- 2 University of South Florida, Tampa, FL, USA.,3 Fundación Raíces, Esmeraldas, Ecuador
| | - Carlos Rosas
- 4 Universidad San Francisco de Quito, Quito, Ecuador
| | | | | | - Eknath Naik
- 2 University of South Florida, Tampa, FL, USA
| | | | - Enrique Teran
- 4 Universidad San Francisco de Quito, Quito, Ecuador
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Samari G, Seltzer JA. Risky sexual behavior of foreign and native-born women in emerging adulthood: The long reach of mother-daughter relationships in adolescence. SOCIAL SCIENCE RESEARCH 2016; 60:222-235. [PMID: 27712681 PMCID: PMC5116325 DOI: 10.1016/j.ssresearch.2016.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 02/01/2016] [Accepted: 06/06/2016] [Indexed: 05/31/2023]
Abstract
Parents' influence on young adult sexual behavior receives little attention compared to influence on adolescent behavior. Yet effective parenting should have lasting effects. Even fewer studies examine parents' influence on sexual behavior of both foreign and native-born young adults. Using the National Longitudinal Study of Adolescent to Adult Health (Add Health) Waves I (1994-95) and III (2001-02), we examine longitudinal associations among mother-daughter relationship quality and nativity during adolescence and young adults' risky sexual behaviors of condom use at last intercourse, number of sexual partners, and STI diagnoses (N = 4460). Women, 18-26 years old, who had good mother-adolescent daughter relationships have fewer partners and STIs in the past year. Second generation women have worse mother-adolescent daughter relationships, compared to third generation. Relationship quality does not explain associations between nativity and risky behavior. Lasting associations between relationship quality and risk behaviors suggest that reproductive health interventions should enhance mother-adolescent relationships.
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Affiliation(s)
- Goleen Samari
- Population Research Center, University of Texas at Austin, United States.
| | - Judith A Seltzer
- Department of Sociology and California Center for Population Research, University of California, Los Angeles, Los Angeles, CA, United States.
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Miller KS, Boyer CB, Cotton G. The STD and HIV Epidemics in African American Youth: Reconceptualizing Approaches to Risk Reduction. JOURNAL OF BLACK PSYCHOLOGY 2016. [DOI: 10.1177/0095798403259248] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sexually transmitted infections, including human immunodeficiency virus (HIV), disproportionately affect African American adolescents and young adults. Many of our current strategies and approaches have been inadequate in the promotion of risk reduction among youth and need to be reconceptualized. This article identifies issues that may guide researchers to better address the risks faced by African American youth. Some of these issues include tailoring of intervention messages and programs, timing of intervention delivery, consideration of contextual factors that influence risk behaviors, and increasing the breadth of our intervention focus. Discussions of how these strategies and approaches may enhance intervention effectiveness are highlighted.
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Attitudes Towards Power in Relationships and Sexual Concurrency Within Heterosexual Youth Partnerships in Baltimore, MD. AIDS Behav 2015; 19:2280-90. [PMID: 26054391 DOI: 10.1007/s10461-015-1105-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Sexual concurrency may increase risk for HIV/STIs among youth. Attitudes about gender roles, including power balances within sexual partnerships, could be a driver. We examined this association among Baltimore youth (N = 352), aged 15-24. Data were collected from February, 2011 to May, 2013. We examined whether index concurrency in male-reported partnerships (N = 221) and sex partner's concurrency in female-reported partnerships (N = 241) were associated with youth's attitudes towards relationship power. Males with more equitable beliefs about power were less likely to report index concurrency. Females with more equitable beliefs were more likely to report sex partner's concurrency. The relationship was significant in main and casual partnerships among females and main partnerships among males. The strongest associations were detected among middle-socioeconomic status (SES) males and low-SES and African American females. Implementing interventions that recognize the complex relationship between socioeconomic context, partner dynamics, gender, and sexual behavior is an important step towards reducing HIV/STI risk among youth.
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Sanchez DM, Schoenbach VJ, Harvey SM, Warren JT, Adimora AA, Poole C, Leone PA, Agnew CR. Association of perceived partner non-monogamy with prevalent and incident sexual concurrency. Sex Transm Infect 2015; 92:266-71. [PMID: 26574570 DOI: 10.1136/sextrans-2015-052111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 10/17/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Concurrency is suggested as an important factor in sexually transmitted infection transmission and acquisition, though little is known regarding factors that may predict concurrency initiation. We examined the association between perception of a partner's non-monogamy (PPNM) and simultaneous or subsequent concurrency among at-risk heterosexual young adults in the Los Angeles area. METHODS We used Poisson regression models to estimate the relationship between PPNM and incident concurrency among 536 participants participating in a cohort study, interviewed at 4-month periods during 1 year. Concurrency was defined as an overlap in reported sexual partnership dates; PPNM was defined as believing a partner was also having sex with someone else. RESULTS Participants (51% female; 30% non-Hispanic white, 28% non-Hispanic black, 27% Hispanic/Latino) had a mean age of 23 years and lifetime median of nine sex partners. At each interview (baseline, 4-month, 8-month and 12-month), 4-month concurrency prevalence was, respectively, 38.8%, 27.4%, 23.1% and 24.5%. Four-month concurrency incidence at 4, 8 and 12 months was 8.5%, 10.6% and 17.8%, respectively. Participants with recent PPNM were more likely to initiate concurrency (crude 4-month RR=4.6; 95% CI 3.0, 7.0; adjusted 4-month RR=4.0, 95% CI 2.6 to 6.1). CONCLUSIONS Recent PPNM was associated with incident concurrency. Among young adults, onset of concurrency may be stimulated, relatively quickly, by the PPNM. Programmes which promote relationship communication skills and explicit monogamy expectations may help reduce concurrency.
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Affiliation(s)
- Diana M Sanchez
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Victor J Schoenbach
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - S Marie Harvey
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Jocelyn T Warren
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Adaora A Adimora
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Charles Poole
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Peter A Leone
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Christopher R Agnew
- Department of Psychological Sciences, Purdue University, West Lafayette, Indiana, USA
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Manning WD, Longmore MA, Copp J, Giordano PC. The complexities of adolescent dating and sexual relationships: fluidity, meaning(s), and implications for young adults' well-being. New Dir Child Adolesc Dev 2015; 2014:53-69. [PMID: 24962362 DOI: 10.1002/cad.20060] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The complexity of adolescents' dating and sexual lives is not easily operationalized with simple indicators of dating or sexual activity. While building on prior work that emphasizes the "risky" nature of adolescents' intimate relationships, we assess whether a variety of indicators reflecting the complexity of adolescents' relationships influence early adult well-being (i.e., depressive symptoms, self-esteem, gainful activity, intimate partner violence, and relationship quality). Our analysis of longitudinal data from the Toledo Adolescent Relationships Study showed that the number of adolescent dating and sexual partners does not uniformly influence indicators of young adult well-being, which is at odds with a risk framework. The number of dating partners with whom the individual was sexually active, and not the number of "casual" sex partners, increased the odds of intimate partner violence during young adulthood. Relationship churning and sexual nonexclusivity during adolescence were associated with lower relationship quality during young adulthood. Sexual nonexclusivity during adolescence influenced self-reports of depressive symptoms and lower self-esteem among young adults. Future research should develop more nuanced conceptualizations of adolescent dating and sexual relationships and integrate adolescent dating and sexual experiences into research on early adult well-being.
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21
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Hebert LE, Lilleston PS, Jennings JM, Sherman SG. Individual, partner, and partnership level correlates of anal sex among youth in Baltimore City. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:619-629. [PMID: 25583375 DOI: 10.1007/s10508-014-0431-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 10/27/2014] [Accepted: 10/28/2014] [Indexed: 06/04/2023]
Abstract
Anal sex is an efficient mode of STI transmission and studies indicate that anal sex is common among heterosexuals, including adolescents. We examined the association between individual, partner, and sexual partnership-level characteristics with anal sex among a household survey of 263 individuals aged 15-24 years in Baltimore City, Maryland. We used weighted multiple logistic regression to examine correlates of anal sex in a heterosexual partnership by gender. Twenty-nine percent of males and 15% of females reported anal sex in a partnership in the past 6 months. For males, anal sex was associated with having two or more partners in the past 3 months (AOR = 13.93, 95% CI 3.87-50.12), having been tested for HIV (AOR = 0.30, 95% CI 0.12-0.72), and oral sex with a partner (AOR = 8.79, 95% CI 1.94-39.78). For females, anal sex was associated with reporting having a main partner (AOR = 6.74, 95% CI 1.74-23.65), partner meeting place (AOR = 3.03, 95% CI 1.04-8.82), partner history of STI (AOR = 0.20, 95% CI 0.05-0.85), and oral sex with a partner (AOR = 8.47, 95% CI 1.08-66.25). Anal sex was associated with inconsistent condom use for both males (OR = 5.77, 95% CI 1.68-19.79) and females (OR = 5.16, 95% CI 1.46-18.30). We conclude that anal sex is a prevalent risk behavior among heterosexual youth and is associated with a range of factors at the individual and partnership levels. These findings provide support for comprehensive sex education that includes information about anal sex; findings from this study can inform public health campaigns targeting youth at risk for STIs.
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Affiliation(s)
- Luciana E Hebert
- Department of Obstetrics and Gynecology, Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, University of Chicago, 1225 E. 60th Street, Rm 122, Chicago, IL, 60637, USA,
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Ryser MD, McGoff K, Herzog DP, Sivakoff DJ, Myers ER. Impact of coverage-dependent marginal costs on optimal HPV vaccination strategies. Epidemics 2015; 11:32-47. [PMID: 25979280 DOI: 10.1016/j.epidem.2015.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 01/26/2015] [Accepted: 01/27/2015] [Indexed: 12/22/2022] Open
Abstract
The effectiveness of vaccinating males against the human papillomavirus (HPV) remains a controversial subject. Many existing studies conclude that increasing female coverage is more effective than diverting resources into male vaccination. Recently, several empirical studies on HPV immunization have been published, providing evidence of the fact that marginal vaccination costs increase with coverage. In this study, we use a stochastic agent-based modeling framework to revisit the male vaccination debate in light of these new findings. Within this framework, we assess the impact of coverage-dependent marginal costs of vaccine distribution on optimal immunization strategies against HPV. Focusing on the two scenarios of ongoing and new vaccination programs, we analyze different resource allocation policies and their effects on overall disease burden. Our results suggest that if the costs associated with vaccinating males are relatively close to those associated with vaccinating females, then coverage-dependent, increasing marginal costs may favor vaccination strategies that entail immunization of both genders. In particular, this study emphasizes the necessity for further empirical research on the nature of coverage-dependent vaccination costs.
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Affiliation(s)
- Marc D Ryser
- Department of Mathematics, Duke University, Durham, NC 27708, USA.
| | - Kevin McGoff
- Department of Mathematics, Duke University, Durham, NC 27708, USA
| | - David P Herzog
- Department of Mathematics, Drake University, Des Moines, IA 50311, USA
| | - David J Sivakoff
- Department of Statistics, The Ohio State University, Columbus, OH 43210, USA; Department of Mathematics, The Ohio State University, Columbus, OH 43210, USA
| | - Evan R Myers
- Department of Obstetrics and Gynecology, Duke University Medical School, Durham, NC 27708, USA
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23
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Vasilenko SA, Lanza ST. Predictors of multiple sexual partners from adolescence through young adulthood. J Adolesc Health 2014; 55:491-7. [PMID: 24561033 PMCID: PMC4139487 DOI: 10.1016/j.jadohealth.2013.12.025] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 12/20/2013] [Accepted: 12/24/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE To examine time-varying associations between predictors of recent multiple sexual partners from middle adolescence through young adulthood. METHODS We examined whether the odds of multiple partners in the past year were differentially predicted by substance use and depression over time, using data from a nationally representative longitudinal study (N = 11,963, 52.2% female, 18.3% African-American, 11.9% Hispanic, 3.5% Asian, 2.6% other race, M age at Wave I = 16.1 years, SD = 1.8). Data were analyzed using the time-varying effect model, which estimates associations between predictors and an outcome as a function of near-continuous time. RESULTS The proportion of participants having multiple partners increased over time, leveling off at around 30% after age 20. Significant positive associations between substance use and multiple partners were strongest early in adolescence and decreased sharply by around age 18. The significant positive association between depression and sexual behavior weakened with age, remaining significant in young adulthood for women but not men. CONCLUSIONS These findings suggest that factors associated with having multiple recent sexual partners change from middle adolescence through young adulthood. The time-varying effect model can be used to identify risk factors that are especially salient at different ages, thus identifying which age periods may hold the greatest promise for intervention.
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Affiliation(s)
- Sara A Vasilenko
- The Methodology Center, The Pennsylvania State University, State College, Pennsylvania.
| | - Stephanie T Lanza
- The Methodology Center, The Pennsylvania State University, State College, Pennsylvania
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Jennings JM, Hensel DJ, Tanner AE, Reilly ML, Ellen JM. Are social organizational factors independently associated with a current bacterial sexually transmitted infection among urban adolescents and young adults? Soc Sci Med 2014; 118:52-60. [PMID: 25089964 DOI: 10.1016/j.socscimed.2014.07.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 07/15/2014] [Accepted: 07/28/2014] [Indexed: 11/19/2022]
Abstract
This study explored the relationship between the social organization of neighborhoods including informal social control and social cohesion and a current bacterial sexually transmitted infection (STI) among adolescents and young adults in one U.S. urban setting. Data for the current study were collected from April 2004 to April 2007 in a cross-sectional household study. The target population included English-speaking, sexually-active persons between the ages of 15 and 24 years who resided in 486 neighborhoods. The study sample included 599 participants from 63 neighborhoods. A current bacterial STI was defined as diagnosis of a chlamydia and/or gonorrhea infection at the time of study participation. Participants reported on informal social control (i.e. scale comprised of 9 items) and social cohesion (i.e. scale comprised of 5 items) in their neighborhood. In a series of weighted multilevel logistic regression models stratified by gender, greater informal social control was significantly associated with a decreased odds of a current bacterial STI among females (AOR 0.53, 95% CI 0.34, 0.84) after controlling for individual social support and other factors. The association, while in a similar direction, was not significant for males (AOR 0.73, 95% CI 0.48, 1.12). Social cohesion was not significantly associated with a current bacterial STI among females (OR 0.85, 95% CI 0.61, 1.19) and separately, males (OR 0.98, 95% CI 0.67, 1.44). Greater individual social support was associated with an almost seven-fold increase in the odds of a bacterial STI among males (AOR 6.85, 95% CI 1.99, 23.53), a finding which is in contrast to our hypotheses. The findings suggest that neighborhood social organizational factors such as informal social control have an independent relationship with sexual health among U.S. urban youth. The causality of the relationship remains to be determined.
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Affiliation(s)
- Jacky M Jennings
- Center for Child and Community Health Research (CCHR), Department of Pediatrics, School of Medicine, Johns Hopkins University, Bayview Medical Center, 5200 Eastern Ave, Mason F Lord Building, Center Tower Ste 4200, Baltimore, MD 21224, USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
| | - Devon J Hensel
- Department of Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine, 410 W. 10th Street Room 10001, Indianapolis, IN 46202, USA; Department of Sociology, Indiana University Purdue University Indianapolis, 425 University Blvd, Indianapolis, IN 46202, USA
| | - Amanda E Tanner
- Department of Public Health Education, University of North Carolina Greensboro, PO Box 26170, Greensboro, NC 27402, USA
| | - Meredith L Reilly
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Baltimore, MD 21205 USA
| | - Jonathan M Ellen
- Center for Child and Community Health Research (CCHR), Department of Pediatrics, School of Medicine, Johns Hopkins University, Bayview Medical Center, 5200 Eastern Ave, Mason F Lord Building, Center Tower Ste 4200, Baltimore, MD 21224, USA; Department of Pediatrics, School of Medicine, Johns Hopkins University, All Children's Hospital Johns Hopkins Medicine, Office of the President, 501 6th Avenue South, Box 9530, St. Petersburg, FL 33701, USA
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Perceived neighborhood partner availability, partner selection, and risk for sexually transmitted infections within a cohort of adolescent females. J Adolesc Health 2014; 55:122-7. [PMID: 24393545 PMCID: PMC4065813 DOI: 10.1016/j.jadohealth.2013.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 11/11/2013] [Accepted: 11/12/2013] [Indexed: 11/23/2022]
Abstract
PURPOSE This research examined the association between a novel measure of perceived partner availability and discordance between ideal and actual partner characteristics as well as trajectories of ideal partner preferences and perceptions of partner availability over time. METHODS A clinic-recruited cohort of adolescent females (N = 92), aged 1619 years, were interviewed quarterly for 12 months using audio computer-assisted self-interview. Participants ranked the importance of characteristics for their ideal main sex partner and then reported on these characteristics for their current main partner. Participants reported on perceptions of availability of ideal sex partners in their neighborhood. Paired t-tests examined discordance between ideal and actual partner characteristics. Random-intercept regression models examined repeated measures. RESULTS Actual partner ratings were lower than ideal partner preferences for fidelity, equaled ideal preferences for emotional support and exceeded ideal preferences for social/economic status and physical attractiveness. Discordance on emotional support and social/economic status was associated with sex partner concurrency. Participants perceived low availability of ideal sex partners. Those who perceived more availability were less likely to be ideal/actual discordant on fidelity [OR = .88, 95% CI: .78, 1.0]. Neither ideal partner preferences nor perceptions of partner availability changed over 12 months. CONCLUSIONS Current main sex partners met or exceeded ideal partner preferences in all domains except fidelity. If emotional needs are met, adolescents may tolerate partner concurrency in areas of limited partner pools. Urban adolescent females who perceive low availability may be at increased risk for sexually transmitted infection (STI) because they may be more likely to have nonmonogamous partners.
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A partner-related risk behavior index to identify people at elevated risk for sexually transmitted infections. J Prim Prev 2014; 34:81-7. [PMID: 23355254 DOI: 10.1007/s10935-013-0290-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to develop and test a sexual-partner-related risk behavior index to identify high-risk individuals most likely to have a sexually transmitted infection (STI). Patients from five STI and adolescent medical clinics in three US cities were recruited (N = 928; M age = 29.2 years). Data were collected using audio-computer-assisted self-interviewing. Of seven sexual-partner-related variables, those that were significantly associated with the outcomes were combined into a partner-related risk behavior index. The dependent variables were laboratory-confirmed infection with Chlamydia trachomatis, Neisseria gonorrhoeae, and/or Trichomonas vaginalis. Nearly one-fifth of the sample (169/928; 18.4%) tested positive for an STI. Three of the seven items were significantly associated with having one or more STIs: sex with a newly released prisoner, sex with a person known or suspected of having an STI, and sexual concurrency. In combined form, this three-item index was significantly associated with STI prevalence (p < .001). In the presence of three covariates (gender, race, and age), those classified as being at-risk by the index were 1.8 times more likely than those not classified as such to test positive for an STI (p < .001). Among individuals at risk for STIs, a three-item index predicted testing positive for one or more of three STIs. This index could be used to prioritize and guide intensified clinic-based counseling for high-risk patients of STI and other clinics.
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Leivers S, Simmons LW. Human Sperm Competition. ADVANCES IN THE STUDY OF BEHAVIOR 2014. [DOI: 10.1016/b978-0-12-800286-5.00001-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Abstract
PURPOSE OF REVIEW Pelvic inflammatory disease (PID) is a common and serious reproductive health disorder and disease rates remain unacceptably high among adolescent girls and young adult women in the United States. Despite data demonstrating that women experience major adverse health outcomes after PID, national recommendations for management of adolescents have become increasingly less cautious in an era of cost-containment. In this review, we take an alternative look at published data on adolescents with PID to frame the next steps for optimizing management for this vulnerable population. RECENT FINDINGS Several findings emerge from review of the literature. First, there is limited evidence to guide the best practice strategies for adolescents with PID due to low enrolment of early and middle adolescents in national trials. Second, adolescents and adult women in the United States receive suboptimal treatment regimens per Centers for Disease Control and Prevention (CDC) standards. Third, available evidence suggests that adolescents are at an increased risk for poor adherence to CDC recommendations for self-care, reacquisition of sexually transmitted infections (STIs) and PID, and subsequent adverse reproductive health outcomes. SUMMARY Efforts to develop and integrate adolescent-focused, evidence-based strategies for PID management and prevention of subsequent STIs and recurrent PID are warranted.
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Affiliation(s)
- Maria Trent
- Department of Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Population, Family, & Reproductive Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Morrison-Beedy D, Jones SH, Xia Y, Tu X, Crean HF, Carey MP. Reducing sexual risk behavior in adolescent girls: results from a randomized controlled trial. J Adolesc Health 2013; 52:314-21. [PMID: 23299011 PMCID: PMC3580004 DOI: 10.1016/j.jadohealth.2012.07.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 07/03/2012] [Accepted: 07/06/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Teenage girls in low-income urban settings are at an elevated risk for HIV, sexually transmitted infections, and unintended pregnancies. The purpose of this study was to evaluate the efficacy of a sexual risk-reduction (SRR) intervention, supplemented with postintervention booster sessions, targeting low-income, urban, sexually active teenage girls. METHOD Randomized controlled trial in which sexually active urban adolescent girls (n = 738) recruited in a midsize northeastern U.S. city were randomized to a theory-based SRR intervention or to a structurally equivalent health promotion control group. Assessments and behavioral data were collected using audio computer-assisted self-interview at baseline, then at 3, 6, and 12 months postintervention. Both interventions included four small-group sessions and two booster sessions. RESULTS Relative to girls in the control group, girls receiving the SRR intervention were more likely to be sexually abstinent; if sexually active, they showed decreases in (a) total episodes of vaginal sex at all follow-ups, (b) number of unprotected vaginal sex acts at 3 and 12 months, and (c) total number of sex partners at 6 months. Medical record audits for girls recruited from a clinical setting (n = 322) documented a 50% reduction in positive pregnancy tests at 12 months. CONCLUSIONS Theory-based behavioral interventions tailored to adolescent girls can help to reduce sexual risk and may also reduce unintended pregnancies. Although sexually active at enrollment, many of the girls receiving the intervention were more likely to practice secondary abstinence. Continued refinement of SRR interventions for girls is needed to ensure they are feasible, appealing, and effective.
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Affiliation(s)
- Dianne Morrison-Beedy
- USF Health Dean, College of Nursing, University of South Florida, Tampa, FL 33612, USA.
| | | | - Yinglin Xia
- Research Assistant Professor, Department of Biostatistics and Computational Biology, University of Rochester Medical Center
| | - Xin Tu
- Professor and Associate Chair, Department of Biostatistics and Computational Biology, Director, Statistical Consulting Service: Director, Division of Psychiatric Statistics, University of Rochester
| | - Hugh F. Crean
- Assistant Professor of Clinical Nursing, Center for Research & Evidence-Based Practice School of Nursing, University of Rochester
| | - Michael P. Carey
- Professor of Psychiatry and Human Behavior, Professor of Behavioral and Social Sciences, and Director, Centers for Behavioral and Preventive Medicine, The Miriam Hospital and Warren Alpert Medical School of Brown University
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Haydon AA, Herring AH, Halpern CT. Associations between patterns of emerging sexual behavior and young adult reproductive health. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2012; 44:218-27. [PMID: 23231329 PMCID: PMC3531866 DOI: 10.1363/4421812] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
CONTEXT Identifying young adult outcomes associated with adolescent sexual behavior, including patterns of first oral, vaginal and anal sex, is critical to promoting healthy sexual development. METHODS Associations between patterns of emerging sexual behavior, defined using latent class analysis, and young adult sexual and reproductive health were examined among 9,441 respondents to Waves 1 (1994-1995), 3 (2001-2002) and 4 (2008) of the National Longitudinal Study of Adolescent Health. Logistic regression analyses examined associations between class membership and young adult outcomes, and tested for interactions by race and ethnicity. RESULTS Compared with respondents who initiated vaginal sex first and reported other sexual behaviors within two years, those who initiated oral and vaginal sex during the same year had similar odds of having had an STD diagnosis ever or in the last year, of having had concurrent sexual partnerships in the last year and of having exchanged sex for money. However, respondents who postponed sexual activity had reduced odds of each outcome (odds ratios, 0.2-0.4); those who initiated vaginal sex and reported only one type of sexual behavior had reduced odds of reporting STD diagnoses and concurrent partnerships (0.4-0.6). Respondents who reported early initiation of sexual activity combined with anal sex experience during adolescence had elevated odds of having had concurrent partnerships (1.6). The data suggest racial and ethnic disparities even when patterns of emerging sexual behavior were the same. CONCLUSIONS Patterns of early sexual behavior considered high-risk may not predict poor sexual and reproductive health in young adulthood.
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Affiliation(s)
- Abigail A Haydon
- American Association for the Advancement of Science/ American Psychological Association, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
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Variation in concurrent sexual partnerships and sexually transmitted diseases among African men in Cape Town, South Africa. Sex Transm Dis 2012; 39:537-42. [PMID: 22706216 DOI: 10.1097/olq.0b013e31824cc0c1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Most studies that assess the relationship between concurrent sexual partnerships and sexually transmitted diseases (STDs) use dichotomous measures of whether concurrency was reported or not. However, different forms of concurrency have different degrees of associated risk for disease transmission, and this should be considered. This article examines variation in both individual concurrency and partner concurrency among African men in Cape Town, South Africa, and assesses the relationship between different types of concurrent partnerships and STDs. METHODS Longitudinal data from sexual partner history tables are used to form measures of concurrency and the type of partner (main vs. nonmain) and degree of condom use (consistent vs. inconsistent) associated with these concurrent relationships. Cross-sectional data from a self-administered module are also used to assess the number of partners men have had concurrently and duration of individual concurrency. Probit regression models assess the association between the partner concurrency measures and self-reported STD history. RESULTS Substantial differences between concurrent sexual partnerships were observed and these variations were associated with different disease risk. Men had a greater chance of reporting an STD when partner concurrency was associated with main partners and inconsistent condom use. CONCLUSION Partnership dynamics must be taken into account in studies assessing the role of concurrency in STD transmission.
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Erlandsson K, Jinghede Nordvall C, Ohman A, Häggström-Nordin E. Qualitative interviews with adolescents about "friends-with-benefits" relationships. Public Health Nurs 2012; 30:47-57. [PMID: 23294387 DOI: 10.1111/j.1525-1446.2012.01040.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the thoughts, reflections, and experiences of friends-with-benefits relationships among a group of Swedish adolescents. DESIGN AND SAMPLE A qualitative study with an explorative and descriptive design. Eight adolescents, aged 16-18, were interviewed. MEASURES Individual in-depth interviews were undertaken. Data were analyzed using latent content analysis. RESULTS The informants involved themselves in Friends-with-benefits (FWB) relationships to find physical and psychological intimacy without any expectations or demands. FWB relationships were perceived to have more advantages when the partner was a close friend with whom an informant felt comfortable. There was ambivalence about the legitimacy of romantic feelings in an FWB relationship, although it was quite common. Sexual concurrency was common and often accepted. Sexual risk-taking behavior involving the use of alcohol and a lack of contraception was considered common in FWB relationships. Informants requested more education and support as regards their sexual behavior. CONCLUSIONS FWB relationships were often initiated to find physical and psychological intimacy with no expectations or demands. Advantages such as sexual concurrency and no demands were central. A deeper understanding of how adolescents think and reason about sexuality and relationships can make a difference when working to improve young people's sexual and reproductive health.
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Affiliation(s)
- Kerstin Erlandsson
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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Montealegre JR, Risser JM, Selwyn BJ, McCurdy SA, Sabin K. Prevalence of HIV risk behaviors among undocumented Central American immigrant women in Houston, Texas. AIDS Behav 2012; 16:1641-8. [PMID: 22249955 DOI: 10.1007/s10461-011-0130-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Undocumented Central American immigrants in the United States are disproportionately affected by HIV infection. However, epidemiological data on sexual behaviors among undocumented women are sparse and the extent to which behaviors vary by duration of residence in the U.S.is largely unknown. In 2010, we used respondent driven sampling to conduct an HIV behavioral survey among Central American immigrant women residing in Houston, Texas without a valid U.S. visa or residency papers. Here we describe the prevalence of sexual risk behaviors and compare recent (5 years or less in the U.S.) and established immigrants (over 5 years in the U.S.) to elucidate changes in sexual risk behaviors over time. Our data suggest that recent immigrants have less stable sexual partnerships than established immigrants, as they are more likely to have multiple and concurrent sexual partnerships, as well as partnerships of shorter duration.
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Affiliation(s)
- Jane R Montealegre
- Division of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, Houston, USA.
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When they break up and get back together: length of adolescent romantic relationships and partner concurrency. Sex Transm Dis 2012; 39:281-5. [PMID: 22421694 DOI: 10.1097/olq.0b013e318244ac31] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sex partner concurrency is an important risk factor for sexually transmitted infection transmission. Understanding how adolescents conceptualize the length of their relationships when they break up and get back together is essential to the assessment of concurrency. METHODS A prospective cohort of 392 late adolescents and emerging adults, aged 14 to 19 years at baseline, were recruited from 2 clinics in Baltimore, MD and interviewed semiannually for 3 years. At each interview, participants were asked to report on all of their sexual partners in the previous 6 months, the length of relationship, and whether they thought their partner had other sex partners. For relationships that had broken up and gotten back together, reports of length of the relationship were compared before and after the breakup. Random effects logistic regression was used to examine the association between length of relationship and both breakup and partner concurrency. RESULTS For relationships that ended and subsequently got back together, participants considered the length of relationship to include the period when they were broken up. Longer relationships were at increased odds of both having broken up and gotten back together (odds ratio [OR] = 1.04, 95% confidence interval [CI]: 1.02, 1.05) and of partner concurrency (OR = 1.03, 95% CI: 1.02, 1.04). The magnitude of the odds of concurrency was greater for relationships that had broken up and gotten back together (OR = 1.07, 95% CI: 1.02, 1.11). CONCLUSIONS Findings from this study emphasize the need for an improved understanding of the association between the temporal dynamics of late adolescent and emerging adult romantic relationships and concurrency.
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Hess KL, Gorbach PM, Manhart LE, Stoner BP, Martin DH, Holmes KK. Risk behaviours by type of concurrency among young people in three STI clinics in the United States. Sex Health 2012; 9:280-7. [PMID: 22697146 PMCID: PMC4077433 DOI: 10.1071/sh11047] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 09/16/2011] [Indexed: 01/26/2023]
Abstract
BACKGROUND Concurrent sexual partnerships can increase sexually transmissible infections (STI) transmission on a population level. However, different concurrency types may be associated with differential risks for transmission. To investigate this, we describe the prevalence and correlates of four specific concurrency types. METHODS Between 2001 and 2004, 1098 young adults attending three STI clinics were interviewed and tested for STIs. Characteristics associated with concurrency types were identified using logistic regression. RESULTS Approximately one-third of respondents reported reactive (34%), transitional (36%), compensatory (32%) and experimental (26%) concurrency. Among men, reactive concurrency was associated with not identifying as heterosexual, drug use and having sex the same day as meeting a partner. Among women, reactive concurrency was associated with African-American race and having >3 lifetime partners. Transitional concurrency was associated with >3 lifetime partners for men and women. Among men, compensatory concurrency was associated with African-American race; among women, there were no associations with compensatory concurrency. Among men, experimental concurrency was associated with >3 lifetime partners and having sex the same day as meeting a partner. Among women, experimental concurrency was associated with not identifying as heterosexual, drug use and having sex the same day as meeting a partner. CONCLUSIONS All concurrency types were common in this population and each was associated with a set of demographic and risk factors. Reactive and experimental concurrency types were associated with other high-risk behaviours, such as drug use.
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Affiliation(s)
- Kristen L Hess
- Department of Epidemiology, University of California, Los Angeles, CA 90024, USA.
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Wheeler R, Earnshaw VA, Kershaw T, Ickovics JR. Postpartum sexually transmitted disease: refining our understanding of the population at risk. Sex Transm Dis 2012; 39:509-13. [PMID: 22706211 PMCID: PMC3942157 DOI: 10.1097/olq.0b013e31824e5167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Scant literature exists on sexually transmitted disease (STD) risk specific to pregnancy and postpartum. The objective of this prospective study is to examine risk factors for incident postpartum STDs among young mothers (ages, 14-25). METHODS Pregnant women were enrolled at <24 weeks gestation (N = 848). Data were collected via in-depth interviews and STD testing conducted in the second and third trimesters and at 6 and 12 months postpartum. Prevalence and incidence of STD diagnosis in pregnancy and postpartum is described. Logistic and linear regression are used to identify risk factors for postpartum infection. RESULTS Forty-four percent of enrolled women never had an STD, 29% had a history of an STD before pregnancy, 28% got an STD during pregnancy, and 27% were diagnosed with an STD postpartum. Incidence of postpartum infection was higher for women who contracted an STD in pregnancy (43%) compared with those with a prior STD (24%) or no STD (19%). In multivariate analysis, STD in pregnancy, having less than high school education, having a new sexual partner, and black race were risk factors for incident postpartum STD. CONCLUSION Prenatal providers should be aware of the significant risk of incident infection among women diagnosed with STDs in pregnancy. Elevated postpartum incidence among those with an STD in pregnancy supports a shift toward more frequent and targeted postpartum STD screening, with implications for clinical care, future research, and interventions.
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Affiliation(s)
- Rebekah Wheeler
- Yale School of Public Health, Center for Interdisciplinary Research on AIDS, New Haven, CT 06520, USA
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von Sternberg K, Cardoso JB, Jun J, Learman J, Velasquez MM. An Examination of the Path Between Recent Sexual Violence and Sexually Transmitted Infections. Womens Health Issues 2012; 22:e283-92. [DOI: 10.1016/j.whi.2012.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 01/21/2012] [Accepted: 01/24/2012] [Indexed: 11/25/2022]
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Gap between consecutive sexual partnerships and sexually transmitted infections among STI clinic patients in St Petersburg, Russia. AIDS Behav 2012; 16:334-9. [PMID: 21448729 DOI: 10.1007/s10461-011-9932-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We conducted a cross-sectional study to determine whether the time between two consecutive sexual partnerships (gap) is associated with sexually transmitted infections (STIs) in Russia. A self-administered questionnaire was administered to STI clinic patients in St. Petersburg and participant's STI data at the time of enrollment in the study was collected from medical charts. The length of the gap between partnerships was divided into four categories: overlapping (0 or negative gap), short gaps (1-90 days), mid-length gaps (91-365 days), and long gaps (366 days or more). Among the 659 respondents, 22.6% had overlapping partnerships, and 13.7, 4.2, and 59.5% had short, mid-length and long gaps, respectively. Short gaps (OR 2.34; 95% CI 1.38-3.95), but not overlapping relationships, were independently associated with STIs when contrasted against long term gaps. HIV prevention programs for Russian STI clinic patients should therefore focus also on prolonging the gap between consecutive, monogamous sexual partnerships.
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Abstract
BACKGROUND Sexual concurrency is associated with higher prevalence of sexually transmitted diseases (STDs) including HIV. However, most studies have focused only on the concurrency of the individual participant (individual concurrency) and not on concurrency of their sexual partners (partner concurrency). Furthermore, limited concurrency information is available in Russia where HIV epidemic is growing rapidly. We therefore examine the prevalence and correlates of individual and partner concurrency, and determine whether either type of concurrency is associated with diagnosed STDs among STD clinic attendees in St. Petersburg, Russia. METHODS In total, 799 attendees were recruited into a cross-sectional study between 2006 and 2008. A questionnaire collected information on demographics, medical history, sexual behaviors, and up to 3 sexual partners during the preceding year. RESULTS The prevalence of individual and partner concurrency was 24.7% and 45.4%, respectively. Both were correlated with marital status, weekly alcohol consumption, age at first sex, and number of lifetime sexual partners. Partner concurrency was significantly associated with diagnosed STDs (odds ratio = 2.06; 95% confidence interval = 1.35-3.15). No significant association between individual concurrency and STDs was observed. CONCLUSIONS Partner concurrency, not individual concurrency, is independently associated with increased odds of having an STD in the studied population.
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Wand H, Ramjee G. The relationship between age of coital debut and HIV seroprevalence among women in Durban, South Africa: a cohort study. BMJ Open 2012; 2:e000285. [PMID: 22223838 PMCID: PMC3253418 DOI: 10.1136/bmjopen-2011-000285] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objectives To investigate the impact of early sexual debut on HIV seroprevalence and incidence rates among a cohort of women. Design Prospective study. Setting KwaZulu-Natal, South Africa. Participants A total of 3492 sexually active women who consented to screen a HIV prevention trial during September 2002 to September 2005; a total of 1485 of them were followed for approximately 24 months. Primary and secondary outcome measures HIV seroprevalence among those who were screened for the trial and HIV seroconversion among those who seroconverted during the study. Results Lowest quintiles of age at sexual debut, less than high school education, a higher number of lifetime sexual partners and lack of cohabitation, being diagnosed as having herpes simplex virus 2 and other sexually transmitted infections were all significantly associated with prevalent HIV infection in multivariate analysis. During follow-up, 148 (6.8 per 100 person-years, 95% CI 5.8 to 8.0) women seroconverted. Highest seroconversion rate was observed among women who had reported to have had sex 15 years or younger (12.0 per 100 person-years, 95% CI 8.0 to 18.0). Overall, impact of risk factors considered in this study was associated with considerable potential reductions in HIV prevalence and incidence rates (population attributable risk: 85%, 95% CI 84% to 87% and population attributable risk: 77%, 95% CI 72% to 82%, respectively). Conclusions The association of HIV status with younger age at sexual debut may likely due to an increased number of lifetime partners. This increase could result from longer duration of sexual life. Prevention of HIV infection should include efforts to delay age at first sex in young women. Trial registration number NCT00121459.
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Affiliation(s)
- Handan Wand
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Gita Ramjee
- HIV Prevention Research Unit, Medical Research Council, Durban, South Africa
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Buszin J, Nieto-Andrade B, Rivas J, Longfield K. Multiple partnerships and risk for HIV among the Garífuna minority population in Belize. Health (London) 2012. [DOI: 10.4236/health.2012.48076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jeffries WL. The number of recent sex partners among bisexual men in the United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2011; 43:151-7. [PMID: 21884382 DOI: 10.1363/4315111] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
CONTEXT Little is known regarding bisexual men's number of recent sex partners, a risk factor for HIV and other STDs. Furthermore, it is unclear if bisexual men have more partners than heterosexual or homosexual men, and whether partner number varies by measures of sexual behavior, identity and attraction. METHODS Sexual orientation-defined separately by sexual behavior during the past year, identity and attraction-was assessed for 3,875 sexually active men aged 15-44 who had participated in the 2002 National Survey of Family Growth. Chi-square and t tests examined differences in background characteristics, behavioral risk factors and number of past-year sex partners by sexual orientation according to each definition. Multivariate ordinary least-squares regression was used to assess predictors of the number of partners. RESULTS When sexual identity and attraction were controlled for, behaviorally bisexual men were predicted to have had 3.1 more past-year partners than behaviorally heterosexual men and 2.6 more than behaviorally homosexual men. After controlling for sexual identity and behavior, bisexual-attracted men had had 0.7 fewer partners than homosexual-attracted men. In a model including background characteristics and behavioral risk factors, behaviorally bisexual men were predicted to have had 2.5-2.6 more partners than others. Neither bisexual identity nor bisexual attraction independently predicted the number of recent partners. CONCLUSION The way in which bisexuality relates to men's number of recent sex partners depends on how sexual orientation is measured. Interventions to reduce behaviorally bisexual men's number of partners will likely lessen their risk for HIV and other STDs.
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Affiliation(s)
- William L Jeffries
- Department of Sociology and Criminology & Law, University of Florida, Gainesville, USA. jeffries@ufl .edu
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Characteristics of women reporting multiple recent sex partners presenting to a sexually transmitted disease clinic for care. Sex Transm Dis 2011; 38:210-5. [PMID: 20966829 DOI: 10.1097/olq.0b013e3181f6fe42] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sexually transmitted disease (STD) clinic attendees are considered to be at higher risk of sexually transmitted infections (STIs) than the general population. However, little is known about STD clinic subpopulations and their unique risks for STI's. The goal of this project was to begin to characterize an important STD clinic subpopulation, the small proportion of women reporting a recent history of multiple sex partners. METHODS Screening of electronic medical records from 2007 identified 347 (7%) women with ≥4 partners in the last 12 months. Records for women with ≥4 sex partners were matched with women reporting 1 sex partner in the last 12 months. Demographic, sexual history, STI history, and laboratory diagnosis(es) were extracted from the electronic medical record and compared using a case-control study design. RESULTS Approximately 5000 women presented to our STD clinic in 2007; 7.0% reported≥4 sex partners. Women with ≥4 sex partners were less often black and on average younger than women with single partners (Median age, 24 vs. 29). They reported more nonvaginal sex, more same-sex contacts, but more consistent condom use than women with single partners. Dyspareunia, genital lesions, abdominal pain, and skin findings were more commonly reported by women with ≥4 sex partners. Women with multiple partners were also more likely to report ever having had ≥3 STI's and were more likely to report a history of gonorrhea or syphilis. They were also more likely to be diagnosed at presentation with chlamydia, gonorrhea, or syphilis. CONCLUSION Women reporting multiple sex partners are an important minority among STD clinic attendees. Understanding the antecedents to high risk sexual behavior as determined by partner number is an important step in reducing STI's in this group.
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Steffenson AE, Pettifor AE, Seage GR, Rees HV, Cleary PD. Concurrent sexual partnerships and human immunodeficiency virus risk among South African youth. Sex Transm Dis 2011; 38:459-66. [PMID: 21258268 PMCID: PMC3763704 DOI: 10.1097/olq.0b013e3182080860] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To estimate the prevalence of concurrency (more than 1 sex partner overlapping in time), the attitudes/behaviors of those engaged in concurrency, length of relationship overlap, and the association between concurrency and human immunodeficiency virus (HIV) among South Africans aged 15 to 24 years. METHODS A cross-sectional, nationally representative, household survey of HIV infection, and sexual attitudes and behaviors was conducted among 11,904 15 to 24 year old South Africans in 2003. Analyses were conducted among sexually experienced youth. RESULTS Men were more likely to report having concurrent (24.7%) than serial partners (5.7%) in the past 12 months, but concurrency was not associated with HIV. Among women, concurrency and serial monogamy were equally common (4.7%), and concurrency, defined by respondent reports of multiple ongoing partners, was associated with HIV in multivariate analysis (odds ratio, 3.4; 95% confidence interval, 1.8-6.5). Median length of relationship overlap was approximately 4 months for women and 3 months for men. Compared to serial monogamists, concurrents reported less consistent condom use, and female concurrents were more likely to report transactional sex and problems negotiating condoms and refusing intercourse. CONCLUSIONS Concurrency is a common partnership pattern among those youth with multiple partners, especially men. For women, having concurrent relationships may be associated with relationship power imbalances and less ability to protect against HIV. Given the prevalence and likely significance of concurrency in the spread of HIV throughout a sexual network, our findings underscore the need for prevention efforts targeting fidelity.
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Scott ME, Wildsmith E, Welti K, Ryan S, Schelar E, Steward-Streng NR. Risky adolescent sexual behaviors and reproductive health in young adulthood. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2011; 43:110-118. [PMID: 21651710 DOI: 10.1363/4311011] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
CONTEXT Little research links adolescent risk behaviors to reproductive health outcomes beyond adolescence, although young adults--men and women in their early 20s--bear a disproportionate burden of STDs and unintended childbearing. METHODS To assess whether individuals who engaged in risk behaviors during adolescence had increased risk of negative reproductive health outcomes in young adulthood, data from Waves 1-4 of the National Longitudinal Study of Adolescent Health on 5,798 sexually active respondents were analyzed. Logistic and multinomial logistic regressions examined associations between risk behaviors (cumulatively and individually) and each of three outcomes. RESULTS Four in 10 youth reported at least three risk factors during adolescence. Women who were exposed to an increasing number of risks had an elevated likelihood of having had multiple sex partners in the last year, rather than none (relative risk ratio, 1.3); having had an STD (odds ratio, 1.1); and having had an intended or unintended birth, as opposed to no birth (relative risk ratio, 1.1 for each). Inconsistent contraceptive use and having had multiple partners, a non-monogamous partner or a non-romantic partner were associated with reporting multiple partners in the last year; inconsistent use, sexual debut after age 16 and not discussing contraception with a partner were associated with having any birth. CONCLUSIONS Teenagers' sexual behaviors have both short-term and long-term consequences, and interventions that focus on multiple domains of risk may be the most effective in helping to promote broad reproductive health among young adults.
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Polk S, Ellen JM, Chung SE, Huettner S, Jennings JM. Discordance between adolescent real and ideal sex partners and association with sexually transmitted infection risk behaviors. J Adolesc Health 2011; 48:604-9. [PMID: 21575821 PMCID: PMC3150491 DOI: 10.1016/j.jadohealth.2010.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 09/09/2010] [Accepted: 09/09/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE Epidemic levels of sexually transmitted infections (STIs) among urban youth have drawn attention to the potential role of sex partner selection in creating risk for STIs. The objectives of this study were to describe the ideal preferences and real selection of sex partners, to evaluate sex partner ideal versus real discordance using quantitative methods, and to determine the association between discordance and STI risk behaviors. METHODS Data are obtained from an urban, household sample of 429 individuals aged 15-24 years. Trait clusters were developed for participants' ratings of their real and ideal sex partners and tested for reliability. Discordance between the ratings of real and ideal partners was measured. Logistic regression was used to assess associations between sex partner discordance and STI risk behaviors. RESULTS Ratings of the real sex partners were often lower than participants' ideal sex partner ratings. A total of 33% of male adolescents and young men and 66% of female adolescents and young women were discordant on at least one trait cluster. Male adolescents and young men who were discordant on the emotional support they expected of their partner were more likely to report more than two sex partners in the past 90 days (odds ratio = 2.13, 95% confidence interval: 1.06-4.26) and perceived partner concurrency (odds ratio = 3.85, 95% confidence interval: 1.53-9.72). For female adolescents and young women, discordance on fidelity or emotional support significantly increased the odds of all risk behaviors. CONCLUSION Male and female adolescents with discordant real and ideal sex partner ratings were more likely to report STI-related risk behaviors. Further steps should involve identification of factors associated with ideal versus real sex partner discordance, such as features of the social context.
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Affiliation(s)
- Sarah Polk
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA.
| | - Jonathan M Ellen
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Shang-en Chung
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Steven Huettner
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine
| | - Jacky M Jennings
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
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Dariotis JK, Sifakis F, Pleck JH, Astone NM, Sonenstein FL. Racial and ethnic disparities in sexual risk behaviors and STDs during young men's transition to adulthood. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2011; 43:51-9. [PMID: 21388505 PMCID: PMC3132868 DOI: 10.1363/4305111] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
CONTEXT Racial and ethnic health disparities are an important issue in the United States. The extent to which racial and ethnic differences in STDs among youth are related to differences in socioeconomic characteristics and risky sexual behaviors requires investigation. METHODS Data from three waves of the National Survey of Adolescent Males (1988, 1990-1991 and 1995) were used to examine 1,880 young men's history of STDs and their patterns and trajectories of sexual risk behavior during adolescence and early adulthood. Multinomial and logistic regression analyses were conducted to test whether racial and ethnic differences in STDs are due to the lower socioeconomic status and higher levels of risky sexual behavior among minority groups. RESULTS Young black men reported the highest rates of sexual risk and STDs at each wave and across waves. Compared with white men, black and Latino men had higher odds of maintaining high sexual risk and increasing sexual risk over time (odds ratios, 1.7-1.9). In multivariate analyses controlling for socioeconomic characteristics, black men were more likely than white men to have a history of STDs (3.2-5.0); disparities persisted in analyses controlling for level of risky sexual behavior. CONCLUSIONS Race and ethnicity continue to differentiate young black and Latino men from their white peers in terms of STDs. Prevention programs that target different racial and ethnic subgroups of adolescent men and address both individual- and contextual-level factors are needed to curb STD incidence.
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Affiliation(s)
- Jacinda K Dariotis
- Center for Adolescent Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
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Epperson MW, Khan MR, El-Bassel N, Wu E, Gilbert L. A longitudinal study of incarceration and HIV risk among methadone maintained men and their primary female partners. AIDS Behav 2011; 15:347-55. [PMID: 20063053 DOI: 10.1007/s10461-009-9660-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study examines the longitudinal relationship between personal and sexual partner incarceration and subsequent HIV risk behaviors among drug-involved men and their primary female sexual partners. A random sample of 356 men in methadone treatment in New York City were interviewed at baseline, 6 and 12 months; these men also reported information on their primary female sexual partners. Female partner recent incarceration was associated with subsequent increase in multiple partnerships for the male participants (AOR: 3.31; 95% C.I.: 1.26-8.72, P < .05). Female partner incarceration was also associated with reduced likelihood of subsequent unprotected sex between primary partners (AOR: .13; 95% C.I.: .05-.40, P < .01); this finding is somewhat unique and warrants further investigation. Findings support the notion of mutual influence in the case of female partner incarceration, which is associated with both female partner and male partner risk behaviors. HIV prevention implications are discussed, including the need for couple-based HIV prevention interventions targeting couples affected by incarceration.
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Morrison-Beedy D, Carey MP, Crean HF, Jones SH. Risk behaviors among adolescent girls in an HIV prevention trial. West J Nurs Res 2010; 33:690-711. [PMID: 20921127 DOI: 10.1177/0193945910379220] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adolescent girls remain vulnerable to HIV and other sexually transmitted infections. Understanding their sexual and substance use behaviors is essential to designing effective interventions to reduce their risk. In this study, baseline data were analyzed from 738 adolescent girls ages 15 to 19 years in Rochester, New York. Data on sexual behavior and substance use (lifetime, past 3 months, and most recent sexual experience) were collected. Nearly one half of recent vaginal (42%) and anal (45%) sex acts were not condom protected; 39% had a prior sexually transmitted infection (STI) and 12% were currently infected with an STI. Approximately one third (31%) of girls had more than one sex partner in the past 3 months. Girls with multiple partners reported that their recent sexual experiences were more likely to involve drug and alcohol use by themselves and partners. Adolescent girls, particularly those with multiple sexual partners, continue to report high-risk sexual behaviors and need focused risk-reduction interventions.
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Jemmott JB, Jemmott LS, O'Leary A, Ngwane Z, Icard LD, Bellamy SL, Jones SF, Landis JR, Heeren GA, Tyler JC, Makiwane MB. School-based randomized controlled trial of an HIV/STD risk-reduction intervention for South African adolescents. ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2010; 164:923-9. [PMID: 20921349 PMCID: PMC4349685 DOI: 10.1001/archpediatrics.2010.176] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To test the efficacy of a school-based human immunodeficiency virus/sexually transmitted disease (HIV/STD) risk-reduction intervention for South African adolescents. DESIGN A cluster-randomized, controlled design with assessments of self-reported sexual behavior collected before intervention and 3, 6, and 12 months after intervention. SETTING Primary schools in a large, black township and a neighboring rural settlement in Eastern Cape Province, South Africa. PARTICIPANTS Nine of 17 matched pairs of schools were randomly selected. Sixth-grade students with parent or guardian consent were eligible. INTERVENTIONS Two 6-session interventions based on behavior-change theories and qualitative research. The HIV/STD risk-reduction intervention targeted sexual risk behaviors; the attention-matched health promotion control intervention targeted health issues unrelated to sexual behavior. OUTCOME MEASURES The primary outcome was self report of unprotected vaginal intercourse in the previous 3 months averaged over the 3 follow-ups. Secondary outcomes were other sexual behaviors. RESULTS A total of 1057 (94.5%) of 1118 eligible students (mean age, 12.4 years) participated, with 96.7% retained at the 12-month follow-up. Generalized estimating equation analyses adjusted for clustering from 18 schools revealed that, averaged over the 3 follow-ups, a significantly smaller percentage of HIV/STD risk-reduction intervention participants reported having unprotected vaginal intercourse (odds ratio [OR], 0.51; 95% confidence interval [CI], 0.30-0.85), vaginal intercourse (OR, 0.62; 95% CI, 0.42-0.94), and multiple sexual partners (OR, 0.50; 95% CI, 0.28-0.89), when adjusted for baseline prevalences, compared with health-promotion control participants. CONCLUSION This is the first large-scale, community-level, randomized intervention trial to show significant effects on the HIV/STD sexual risk behavior of South African adolescents in the earliest stages of entry into sexual activity.
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