Association of sexual abuse with incident high-risk human papillomavirus infection among young African-American women

Integrating Individual and Contextual Factors to Explain Disparities in HIV/STI Among Heterosexual African American Youth: A Contemporary Literature Review and Social Ecological Model

Heterosexual African American youth face substantial disparities in sexual health consequences such as HIV and STI. Based on the social ecological framework, the current paper provides a comprehensive, narrative review of the past 14 years of literature examining HIV/STI risk, including risky sexual behavior, among heterosexual African American youth and a conceptual model of risk among this population. The review found that individual psychological and biological factors are insufficient to explain the sexual health disparities faced by this group; instead, structural disadvantage, interpersonal risk, and community dysfunction contribute to the disparity in HIV/STI outcomes directly and indirectly through individual psychological factors. The conceptual model presented suggests that for African American youth, (1) HIV/STI risk commonly begins at the structural level and trickles down to the community, social, and individual levels, (2) risk works in a positive feedback system such that downstream effects compound the influence of structural risks, and (3) contextual and individual risk factors must be considered within the advanced stage of the epidemic facing this population. Despite advanced HIV and STI epidemics among heterosexual African American youth, multisystemic interventions that target structural risk factors and their downstream effects are posited to reduce the disparity among this high-risk population.

Correlates of African American sexual assault survivors' medical care seeking

African American women are at higher risk for sexual assault than other racial/ethnic groups and have an overall high prevalence of lifetime sexual assault. Despite elevated risk and prevalence, African American survivors are often reluctant to use services in the aftermath of sexual assault. Yet, little research has focused exclusively on African American women's sexual assault experiences including their experiences of medical care seeking. A mail survey study was conducted in Chicago (2010-2011) to understand better African American women's sexual assault experiences in relationship to post-assault medical care seeking in a large community sample (N = 836). Multivariable regression analyses examined whether demographics, assault characteristics, trauma history, and post-assault psychosocial factors were related to medical care seeking. Results revealed unique correlates of immediate and long-term help-seeking from a variety of medical/health sources. Being of older age and lower income, perceived life threat, and delayed disclosure were related to less medical care seeking. Survivors who were assaulted by strangers, experienced interpersonal and contextual traumas, and who received tangible aid and mixed social reactions were related to medical care seeking. Implications for research and clinical practice with this population are provided.

Abuse, cancer and sexual dysfunction in women: A potentially vicious cycle

More than 30% of women have a history of abuse. Women with cancer may be at substantially increased risk for abuse, but this issue is rarely discussed in the course of oncology care. Women with a history of abuse who present for cancer care commonly have a high prevalence of co-morbid illness. Sexual dysfunction, a highly prevalent but under-recognized condition among women of all ages, is also more common among both women with a history of abuse and women with cancer. Although common after cancer, sexual dysfunction, like abuse, can be stigmatizing and often goes undiagnosed and untreated. This review first examines the literature for evidence of a relationship between any history of abuse and cancer among women, addressing two questions: 1) How does abuse promote or create risk for developing cancer? 2) How does cancer increase a woman's susceptibility to abuse? We then examine evidence for a relationship between abuse and female sexual dysfunction, followed by an investigation of the complex relationship between all three factors: abuse, sexual dysfunction and cancer. The literature is limited by a lack of harmonization of measures across studies, retrospective designs, and small and idiosyncratic samples. Despite these limitations, it is imperative that providers integrate the knowledge of this complex relationship into the care of women with cancer.

The prevalence of human papillomavirus in pediatric tonsils: a systematic review of the literature

BACKGROUND

HPV-related head and neck cancer rates have been increasing in recent years, with the tonsils being the most commonly affected site. However, the current rate of HPV infection in the pediatric population remains poorly defined. The objective of this study was to systematically review and evaluate the prevalence and distribution of HPV in the tonsils of pediatric patients undergoing routine tonsillectomy.

METHODS AND RESULTS

The literature was searched using PubMed, EMBASE, Scopus, CINAHL, Cochrane Library, and ProQuest Dissertations & Theses Global databases (inception to December 2017) by two independent review authors. Inclusion criteria included articles which evaluated the prevalence of HPV in a pediatric cohort without known warts or recurrent respiratory papillomatosis, those which used tonsil biopsy specimens for analysis, and those with six or more subjects and clear outcomes reported. Eleven studies met the inclusion criteria. Using the Oxford Clinical Evidence-based Medicine (OCEBM) guidelines, two reviewers appraised the level of evidence of each study, extracted data, and resolved discrepancies by consensus. The systematic review identified 11 articles (n = 2520). Seven studies detected HPV in the subject population, with prevalence values ranging from 0 to 21%. The level of evidence for all included studies was OCEBM Level 3.

CONCLUSIONS

HPV may be present in pediatric tonsillectomy specimens; however, the largest included study demonstrated a prevalence of 0%. Future testing should be performed using methods with high sensitivities and specificities, such as reverse transcript real-time PCR or digital droplet PCR.

The Association Between Unwanted Sexual Experiences and Early-Onset Cervical Cancer and Precancer by Age 25: A Case-Control Study

BACKGROUND

We examined the association between unwanted sexual experiences and cervical cancer, cervical intraepithelial neoplasia 3, adenocarcinoma in situ, diagnosed ≤25 years of age.

METHODS

A case-control study of women ≤55 years who attended gynecological hospitals in Australia between 1983 and 2007. Cases were ≤25 years when diagnosed with disease, control group 1 were "older women" >25 years at diagnosis; control group 2 were "well women" ≤25 years attending preventive health clinics. A self-administered postal survey was utilized. The main outcome measures were prevalence of childhood sexual abuse (<16 years) and unwanted adolescent sexual experiences (between 16 and 18 years) in cases compared to controls.

RESULTS

Of 400 contactable subjects, 251 participated (62.8%). Prevalence of childhood sexual abuse in cases (26.6% [25/94]) was similar to other groups. Prevalence of childhood genital contact abuse in cases with cervical cancer was 45.5% [5/11], compared to older women (20% [10/50], p = 0.08) and well women (13.8% [8/58], p = 0.01), and was marginally more common compared to well women when adjusted for other lifestyle factors (odds ratio [OR]: 4.7 [1.0-22.6], p = 0.05). Prevalence of unwanted adolescent sexual experiences in cases was 28.9% [33/114]. Prevalence of adolescent penile-genital contact experiences in cervical cancer cases was 46.7% [7/15], compared to older women (9.4%, [6/64], p < 0.001) and well women (13.7%, [10/73], p = 0.003), and was more common compared to well women when adjusted for lifestyle (OR: 5.9 [1.4-24.9], p = 0.02) and sexual health risk factors (OR: 5.6 [1.4-22.1] p = 0.01).

CONCLUSIONS

Unwanted sexual experiences with genital contact were a risk factor for invasive cervical cancer ≤25 years, likely due to a complex interplay of biological and environmental factors.

Impact of Intimate Partner Forced Sex on HIV Risk Factors in Physically Abused African American and African Caribbean Women

We examined associations between intimate partner forced sex (IPFS) and HIV sexual risk behaviors among physically abused Black women. Women aged 18-55 in intimate relationships were interviewed in health clinics in Baltimore, MD and St. Thomas and St. Croix, US Virgin Islands (USVI). Of 426 physically abused women, 38% experienced IPFS; (Baltimore = 44 and USVI = 116). USVI women experiencing IPFS were more likely to have 3+ past-year sex partners (AOR 2.06, 95% CI 1.03-4.14), casual sex partners (AOR 2.71, 95% CI 1.42-5.17), and concurrent sex partners (AOR 1.94, 95% CI 1.01-3.73) compared to their counterparts. Baltimore women reporting IPFS were more likely to have exchanged sex (AOR 3.57, 95% CI 1.19-10.75). Women experiencing IPFS were more likely to report their abuser having other sexual partners in Baltimore (AOR 3.30, 95% CI 1.22-8.88) and USVI (AOR 2.03, 95% CI 1.20-3.44). Clinicians should consider the influence of IPFS on individual and partnership HIV sexual risk behaviors.

Abuse Impedes Prevention: The Intersection of Intimate Partner Violence and HIV/STI Risk Among Young African American Women

Intimate partner violence (IPV) is associated with risky sexual behavior and STIs among diverse groups of women. IPV was examined as a moderator of efficacy for an HIV/STI intervention. 848 African American women, 18-29, were randomly assigned to an HIV/STI intervention or control condition. Participants completed measures on sociodemographics, IPV, risky sexual behavior and received STI testing. IPV predicted inconsistent condom use and a risky sexual partner over 12-month follow-up. A significant interaction indicated that among women who experienced IPV, those in the intervention were more likely to test positive for Trichomonas vaginalis (TV). Among intervention participants, those who experienced IPV were more likely to test TV-positive than those who did not. In an HIV intervention that did not specifically address IPV, women in the control condition were less likely to acquire TV than those in the intervention. Consideration of contextual/interpersonal factors is essential when developing HIV intervention programs.

Interpersonal- and community-level predictors of intimate partner violence perpetration among African American men

Intimate partner violence (IPV) has been associated with adverse physical, psychoemotional, and sexual health, and African American women are at higher risk for experiencing IPV. Considering African American women predominantly have African American male partners, it is essential to identify factors associated with IPV perpetration among African American men. The present study examined attitudes toward IPV, ineffective couple conflict resolution, exposure to neighborhood violence, and the interplay of these factors as predictors of IPV perpetration. A community sample of 80 single, heterosexual, African American men between 18 and 29 years completed measures assessing sociodemographics, attitudes towards IPV, perceived ineffective couple conflict resolution, exposure to neighborhood violence, and IPV perpetration during the past 3 months. Hierarchical multiple linear regression analyses, with age, education, and public assistance as covariates, were conducted on 65 men who reported being in a main relationship. Couple conflict resolution and exposure to neighborhood violence moderated the relation between attitudes supporting IPV and IPV perpetration. Among men who reported high ineffective couple conflict resolution and high exposure to neighborhood violence, IPV perpetration increased as attitudes supporting IPV increased. The findings indicated that interpersonal- and community-level factors interact with individual level factors to increase the risk of recent IPV perpetration among African American men. While IPV prevention should include individual-level interventions that focus on skills building, these findings also highlight the importance of couple-, community-, and structural-level interventions.

Unintended pregnancy and its correlates among female attendees of sexually transmitted disease clinics in Eastern China

This study is to determine the prevalence of unintended pregnancy and its risk factors among the female attendees of sexually transmitted disease (STD) clinics in Zhejiang Province, China. A self-administered questionnaire survey of a cross-sectional design was administered to attendees at four STD clinics in 2007. Of the 313 female STD clinic attendees, 42.5% reported that they had at least one unintended pregnancy; the induced abortion rate was 39.0%. Over their lifetime, 12.1% responded “use condoms always/often” and 5.4% “always/often used oral contraceptives.” The risk factors for the unintended pregnancy identified by the multivariate analysis were as follows: being married, experience of nonconsensual sex, and a history of STD, having two and over two sexual partners. Unintended pregnancies and induced abortion by female STD clinic attendees have reached an alarming prevalence. Doctors at STD clinics should attach importance not only to the STD problem of the female attendees, but also to the unintended pregnancy and the associated factors. Targeted contraceptive counseling and intervention should be promoted at STD clinics as a strategy to improve the efficiency and effectiveness of the reproductive health services in China.

Barriers to cervical screening in women who have experienced sexual abuse: an exploratory study

OBJECTIVES

To explore self-reported cervical screening history and barriers to attendance among women who have been sexually abused and to identify measures to improve the experience of cervical screening for these women.

METHODS

Women visiting the website of the National Association for People Abused in Childhood (NAPAC), who had been sexually abused, were invited to complete a survey of their views and experiences of cervical screening. This included closed questions on demographic characteristics and cervical screening attendance, open questions on barriers to screening, and the opportunity to submit suggestions to improve this experience for women who have been sexually abused. Content analysis was used to code responses to the open questions. Four women also participated in a discussion group.

RESULTS

Overall, 135 women completed the closed questions and 124 provided open-ended responses. 77.5% of responding women who were eligible for cervical screening in England had ever attended, 48.5% at least once in the previous 5&emsp14;years, but 42.1% of women aged 25-49 within 3&emsp14;years. A total of nine higher order themes were identified related to barriers to screening, one related to intention to attend screening and five related to suggestions to improve screening.

CONCLUSIONS

This study supports the idea that women who have experienced sexual abuse are less likely to attend for regular cervical screening, with under half screened in the last 5&emsp14;years compared to the National Health Service Cervical Screening Programme figure of 78.6%. Suggestions to improve the experience for abused women focused on communication, safety, trust and sharing control. Further research in this area is warranted to ensure that this at-risk population is appropriately served by cervical screening.

Gender differences in sexual risk behaviours and sexually transmissible infections among adolescents in mental health treatment

BACKGROUND

Adolescents with a history of psychiatric disorder(s) are particularly vulnerable to contracting sexually transmissible infections (STIs) as a result of psychological and emotional states associated with higher rates of risky sexual behaviour. The present study examined gender differences in sexual risk behaviours and STI among adolescents in mental health treatment.

METHODS

Three hundred and seventy nine sexually active adolescents, aged 13-18 years, from a larger multisite study, who received mental health treatment during the past year, completed an audio computer-assisted self interview assessing sociodemographics, psychiatric symptomatology and HIV/STI risk behaviours, and provided urine specimens tested for STI.

RESULTS

After controlling for covariates, multivariate logistic regression models indicated that female adolescents were more likely to have had an HIV test (adjusted odds ratio (AOR)=3.2, P=0.0001), obtain their HIV test results (AOR=2.9, P=0.03), refuse sex out of fear for STI acquisition (AOR=1.7, P=0.04), or avoid a situation that might lead to sex (AOR=2.4, P=0.001), and were less likely to have a casual sex partner (AOR=0.40, P=0.002). Additionally, females were more likely to report inconsistent condom use (AOR=2.60, P=0.001) and have a STI (AOR=9.1, P=0.0001) than their male counterparts.

CONCLUSIONS

Female adolescents receiving mental health treatment were more than nine times as likely to have an STI and more likely to use condoms inconsistently. The standard of care for mental health practice for adolescents should include referrals for STI screening and treatment as well as assessment and discussion of risky sexual behaviours as part of the treatment plan when indicated. Effective programs should address gender-specific communication and behavioural skills.

Personal factors influence use of cervical cancer screening services: epidemiological survey and linked administrative data address the limitations of previous research

BACKGROUND

National screening programs have reduced cervical cancer mortality; however participation in these programs varies according to women's personal and social characteristics. Research into these inequalities has been limited by reliance on self-reported service use data that is potentially biased, or administrative data that lacks personal detail. We address these limitations and extend existing research by examining rates and correlates of cervical screening in a large epidemiological survey with linked administrative data.

METHODS

The cross-sectional sample included 1685 women aged 44-48 and 64-68 years from the Australian Capital Territory and Queanbeyan, Australia. Relative risk was assessed by logistic regression models and summary Population Attributable Risk (PAR) was used to quantify the effect of inequalities on rates of cervical cancer screening.

RESULTS

Overall, 60.5% of women participated in screening over the two-year period recommended by Australian guidelines. Screening participation was associated with having children, moderate or high use of health services, employment, reported lifetime history of drug use, and better physical functioning. Conversely, rates of cervical screening were lower amongst women who were older, reliant on welfare, obese, current smokers, reported childhood sexual abuse, and those with anxiety symptoms. A summary PAR showed that effective targeting of women with readily observable risk-factors (no children, no partner, receiving income support payments, not working, obese, current smoker, anxiety, poor physical health, and low overall health service use) could potentially reduce overall non-participation in screening by 74%.

CONCLUSIONS

This study illustrates a valuable method for investigating the personal determinants of health service use by combining representative survey data with linked administrative records. Reliable knowledge about the characteristics that predict uptake of cervical cancer screening services will inform targeted health promotion efforts.

Differences between African-American adolescent females with and without human papillomavirus infection

BACKGROUND

An important policy question is whether high-risk populations can be identified and prioritised for human papillomavirus (HPV) immunisation.

METHODS

Data collection included an audio computer-assisted survey interview and testing of Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, and HPV among 295 African-American adolescent females.

RESULTS

The results indicated that 43.1% tested positive for HPV. Logistic regression analyses indicated that HPV prevalence was not associated with other sexually transmissible infections (prevalence ratio (PR)=0.85, 95% confidence interval (CI)=0.51-1.41), unprotected vaginal sex (PR=1.04, 95% CI=0.56-1.92), having sex with an older male partner (PR=1.12, 95% CI=0.64-1.96), and having a casual partner (PR=0.89, 95% CI=0.54-1.48). Additionally, t-tests indicated that HPV prevalence was not associated with frequency of vaginal sex (t=0.17, P=0.87), protected sex (t=-0.16, P=0.87), number of recent (t=0.40, P=0.69) or lifetime (t=1.45, P=0.15) sexual partners. However, those testing positive for HPV were younger (t=1.97, P=0.05) and reported current use of birth control pills (PR=2.38, 95% CI=1.00-5.63).

CONCLUSIONS

It may not be possible to identify those with elevated risk of HPV acquisition. Thus, HPV vaccination, regardless of risk indicators, may be the most efficacious public health strategy.