Sexual sensation seeking and Sexual Compulsivity Scales: reliability, validity, and predicting HIV risk behavior

Two studies are presented that evaluate newly developed scales of sensation seeking and sexual compulsivity. Results showed that the scales were reliable and correlated with convergent and divergent measures in expected directions in samples of both gay men (N = 296) and inner city low-income men and women (N = 158). Consistent with theories of sensation seeking, the scales corresponded to an attraction toward a range of sexual practices, including increased frequencies of unprotected intercourse and a greater number of sexual partners. As expected, sexual compulsivity was not related to variety and novelty in sexual practices, but was associated with lower levels of self-esteem and resistance to adopting sexual risk-reducing strategies. However important differences were observed between the gay men and heterosexual samples; scales correlated with substance use only among gay men, and sexual compulsivity was related to a range of sexual practices only among heterosexuals. The sensation seeking and Sexual Compulsivity Scales were therefore reliable, appeared valid, and useful in predicting sexual risk behaviors.

Comparison of the declines in CD4 counts in HIV-1-seropositive female sex workers and women from the general population in Nairobi, Kenya

Studies from Kenya have reported rapid clinical disease progression among HIV-infected professional sex workers. The reasons for this rapid decline are unknown. To better understand factors influencing the course of disease, HIV-1 disease progression was explored in terms of declines in CD4 counts. Two samples from Nairobi, Kenya, were studied, one from a cohort of female sex workers and another, as a comparison group, from mothers enrolled in an HIV-1 vertical-transmission study. A Markov model was used to analyze transitions between HIV-1 disease stages as defined by CD4 counts. It appears that sex workers experience a rapid decline in CD4 counts, consistent with earlier findings of rapid clinical disease progression among individuals in this group. The rate of decline in CD4 counts among the mothers appears to be lower. It is speculated that either intensive exposure to sexually transmitted pathogens or infection with several strains of HIV-1 may account for the rapid disease progression among female sex workers.

Primary pulmonary hypertension and the human immunodeficiency virus. Report of two cases and a review of the literature

We report two cases of human immunodeficiency virus (HIV) seropositivity and pulmonary hypertension seen at our institution and present a comprehensive literature review and available histopathologic findings of the association between HIV seropositivity and pulmonary hypertension. Studies and reviews pertaining to HIV seropositivity and pulmonary hypertension were identified through a MEDLINE search and reference citations. All studies and series found in the MEDLINE search were reviewed and are discussed in this article. Where data were available, comparisons and analyses were made between groups of reported cases of HIV seropositivity and pulmonary hypertension with regard to the following parameters: sex distribution, mode of acquiring HIV infection, presence or absence of the acquired immunodeficiency syndrome, CD4 cell counts, PO2 or oxygen saturation by pulse oximetry, concurrent lower respiratory tract infection, and histopathologic features. We conclude that there is strong evidence for pulmonary hypertension associated with HIV infection that is histologically indistinguishable from primary pulmonary hypertension. Consequently, HIV-seropositive patients with unexplained dyspnea should be evaluated for primary pulmonary hypertension. Prospective studies in HIV-positive patients are indicated.

The consequences of a positive prenatal HIV antibody test for women

As more women of childbearing age are affected by the human immunodeficiency virus (HIV), many providers have demanded routine perinatal HIV screening, arguing that the medical benefits of testing outweigh the socioeconomic, medical, and psychological risks of a positive HIV test for women. In this primarily urban poor population, we used a semistructured interview to evaluate differences in health care discrimination, economic losses, risk behaviors, relationships changes, and psychological status in 20 HIV-positive and 20 HIV-negative mothers matched for HIV risk, race, income, and delivery date. Many (35%) seropositive and no seronegative women cited health care discrimination due to HIV status. Although seropositive women reported greater satisfaction with social support from friends (100%) and family (80%), many women had not disclosed their HIV status to any friends (65%) or family (25%), indicating fear of abandonment. Only 56% of HIV positive and 44% of seronegative women knew their partners' HIV status, and many HIV-positive and HIV-negative women reported having sex without condoms after the HIV test. Mean standardized anxiety (p < 0.05) and depression scores were higher in seropositive women. Despite added social support and medical treatments, HIV-positive women showed higher levels of health care discrimination, personal isolation, and psychological sequelae than their seronegative counterparts. As the medical benefits to prenatal HIV testing increase, we will need to develop focused medical, social, and mental health services addressing the needs of HIV-positive women.

The high prevalence of genital herpes among patients with genital ulcer disease in Uganda

BACKGROUND

Genital ulcer disease is a risk factor for transmission of human immunodeficiency virus. One-hundred consecutive Ugandan patients (median age, 25 years) with genital ulcer disease were examined to determine the prevalence of genital herpes and its relationship to human immunodeficiency virus seropositivity.

GOAL OF THIS STUDY

To improve management, prevention, and control of genital ulcer disease, thus reducing human immunodeficiency virus infections attributable to genital ulcer disease.

STUDY DESIGN

This was a prevalence study of genital herpes in a consecutive sample of an urban sexually transmitted disease clinic population.

RESULTS

Forty-nine percent (48/98) of the patients had genital herpes (36% by direct fluorescent antigen and 13% by history of recurrent vesicles). There was a trend toward larger lesions in patients who were human immunodeficiency virus seropositive. Twelve percent (11/89) of patients had syphilis, and 30% (30/100) remained sexually active, despite the presence of active genital ulcer disease. Sixty-five percent of 89 patients tested had antibodies to human immunodeficiency virus.

CONCLUSIONS

Genital herpes is a common cause of genital ulcer disease in patients attending sexually transmitted disease clinics in Uganda, and herpes ulcers may be more extensive among those who are infected with human immunodeficiency virus.

The cost of comprehensive preventive medical services for adolescents

OBJECTIVES

To address the need for clinical preventive services for 11- to 21-year-old males and females and provide cost estimates for those services under a fee-for-service system. Preventive services include screening, health promotion, and immunizations.

DESIGN

The prevalence of adolescent morbidities was derived from national surveys. Estimated costs of these morbidities were obtained from published data and adjusted for 1992 dollars using the Consumer Price Index. The estimated costs of preventive services for adolescents under a fee-for-service system were derived from a 1993 survey of nine Blue Cross and Blue Shield plans and four insurance companies.

MAIN OUTCOME MEASURES

The cost of adolescent morbidities includes only direct medical costs for a single year and excludes long-term and indirect costs. The cost of clinical preventive services is calculated at 100% participation levels.

RESULTS

Each year, an estimated $33.5 billion is spent on medical treatment for select adolescent morbidities, approximately $859 per adolescent per year; this is a conservative estimate. The average cost of clinical preventive services per adolescent per year would be approximately $130 in a fee-for-service system, although these are not entirely "new" costs because payers already incur screening costs for some conditions.

CONCLUSION

The cost-effectiveness of clinical interventions for various health risk behaviors among adolescents is unknown. It appears that preventive interventions would have to eliminate 15% of adolescent morbidities overall to break even in economic terms.

Balancing judicial interests in HIV cases: Part 2, Issues for nurse administrators

Legal issues involving human immunodeficiency virus are consuming an increasing amount of the attention of hospitals and nurse administrators. At times, the legal interests of patients, staff, and administrators conflict, and it is the duty of healthcare administrators to determine which interests should prevail. Recently, two courts have dealt with this problem. In a previous article (JONA October 1995), the author discussed the first case, which involved antidiscrimination versus workplace safety. In this article, the author discusses the second case, which also involves issues of antidiscrimination and workplace safety, but with a decidedly different twist. She identifies the legal dilemma and suggests ways in which nurse administrators can recognize and reconcile such conflicts.

Prospective evaluation of a model of risk for HIV infection among injecting drug users

Data on 3016 out-of-treatment injecting drug users (IDUs) were analyzed in order to replicate findings from an earlier study on risk factors for HIV infection (Iguchi et al., 1992) and evaluate a model for estimating probability of infection. Logistic regression analyses yielded a set of risk factors highly consistent with previous findings. A logistic function was used to estimate subjects' probabilities of infection, and these estimates were strongly correlated with actual HIV prevalence in both the original and current samples. The current study represents a successful replication of earlier findings and supports the validity of the risk model.

Gender differences in high-risk sex behaviours among heterosexual drug injectors and crack smokers

This study was designed to assess gender differences in high-risk sex behaviors related to the transmission of HIV among injection drug users (IDUs) and crack smokers. Using a standard national survey instrument, 593 verified drug users were questioned about their sexual activities and drug use in the 30 day period prior to the interview. High-risk sex behaviors included nonuse of condoms, exchanging sex for drugs or money, sex with an IDU, and sex with more than one partner. Results showed that IDUs who engaged in needle risk practices were more likely report nonuse of condoms than IDUs who practiced safer needle use. African-American ethnicity was a more powerful determinant of exchanging sex than smoking crack cocaine. Sex with more than one partner in the previous 30 day was reported by 11% of married males and 15% of married females. Independently, marital status was found to be a marker for high-risk sex behaviors, in particular, sex with an IDU and nonuse of condoms, behaviors reported more often by married than unmarried respondents. Needle risk, more common among females than males, was associated with sex with an IDU. Approximately one-fourth of the injectors reporting sex with only non-IDUs also reported needle risk, sex with more than one partner, and nonuse of condoms. These findings show the dual threat drug injectors face for HIV infection, through sex and needle risk behaviors, and the pivotal role IDUs play in the heterosexual transmission of HIV to noninjectors.

Risk factors for human immunodeficiency virus seroconversion among out-of-treatment drug injectors in high and low seroprevalence cities. The National AIDS Research Consortium

From 1988 to 1991, 6,882 drug injectors in 15 US cities were interviewed and had serum samples collected. The interviews and samples were analyzed for determination of significant predictors of human immunodeficiency virus (HIV) seroconversion in the 10 low seroprevalence cities and the five high seroprevalence cities. The unit of analysis was the period of observation between consecutive paired interviews/blood samples. In Cox proportional hazards regression, significant predictors of seroconversion in the low seroprevalence cities were: not being in drug treatment, injecting in outdoor settings or abandoned buildings, using crack cocaine weekly or more frequently, engaging in woman-to-woman sex, being of non-Latino race/ethnicity, and city seroprevalence. Predictors in high seroprevalence cities were: injecting with potentially infected syringes, not being in drug treatment, and having a sex partner who injected drugs. These findings suggest that HIV may be concentrated in sociobehavioral pockets of infection in low seroprevalence cities. For reducing HIV transmission, these results suggest: 1) in low seroprevalence cities, localized monitoring to detect specific emerging sociobehavioral pockets of infection, and quick implementation of appropriate targeted interventions if necessary; 2) in high seroprevalence cities, relatively more emphasis on locality-wide outreach and syringe-exchange projects to reduce risky behavior; and 3) in both types of cities, considerable expansion of drug treatment programs.

A case-control study of human immunodeficiency virus type 1 seroconversion and risk-related behaviors in the Chicago MACS/CCS Cohort, 1984-1992. Multicenter AIDS Cohort Study. Coping and Change Study

This paper focuses on 76 human immunodeficiency virus type 1 (HIV-1) seroconverters who concurrently participated in the Chicago, Illinois, component of the Multicenter AIDS Cohort Study (MACS) and the Coping and Change Study (CCS) of homosexual/bisexual men between 1984 and 1992. A nested case-control analysis was performed to assess the critical behavioral risk factors associated with incident HIV-1 infection and the consistency of these relations in early (1984-1988) versus later (1989-1992) phases of the study. Univariate results revealed strong early period associations between seroconversion and various measures of receptive anal intercourse (RAI) that became considerably weaker in the study's later period. The weaker associations reflected the overall decline in levels of RAI among the cohort during the 9 years of observation. In contrast, univariate results revealed stronger later period associations between seroconversion and measures of receptive oral intercourse and insertive anal intercourse. Subsequent multivariate testing did not support the hypothesis that receptive oral intercourse and/or insertive anal intercourse have replaced unprotected RAI as important risk behaviours in the homosexual transmission of HIV-1. In conditional logistic regression models combining intercourse measures with indices of drug and condom use, only the latter variables were consistently associated with HIV-1 seroconversion in both early and later study periods. Adjusted odds ratios (ORs) for nonuse of condoms during RAI were consistently significant throughout the study (ORs = 3.7-4.8), while adjusted odds ratios for recreational drug use variables rose dramatically during the latter half of the study (e.g., for use of cocaine, OR = 81.3 (95% confidence interval 8-824) [corrected], and for use of nitrite "poppers," OR = 9.1 (95% confidence interval 1.8-45.5)). The behavioral intervention applications of these findings, as well as their relation to data from other recent cohort studies of HIV-1 seroconversion among homosexual/bisexual men, are discussed.

[the early diagnosis of the vertical transmission of the human immunodeficiency virus type 1. The evaluation of diagnostic tests]

BACKGROUND

The early diagnosis of vertically transmitted human immunodeficiency virus infection cannot be based on the presence of specific serum antibodies since those of the maternal IgG class pass the placenta and may be detected in children for up to 18 months. Based on this fact, the aim of this study was to evaluate other techniques for early diagnosis of the infection applicable from birth in 306 children of infected mothers.

METHODS

The production of in vitro antibodies, virus culture and polymerase chain reaction (PCR) were used. The sensitivity of the techniques was estimated in the 40 children diagnosed with human immunodeficiency virus infection and specificity was determined in the 266 uninfected children.

RESULTS

The sensitivity for the production of in vitro antibodies was 62.0% at 3 months and 94.7% at 6 months; 90.4% and 88.2%, respectively, for the viral culture and 92.3% and 94.1%, respectively, for the PCR. The specificity of all the cases was higher than 89.4% although varied in relation to age.

CONCLUSIONS

The combination of several diagnostic techniques provides better performance for the early diagnosis of vertical transmission of the human immunodeficiency virus. Given that viral culture takes longer to provide results and is more expensive, it is less recommendable for routine use, although the form of viral replication may be useful to establish the prognosis.

[Is there an increased risk of infection in trauma surgery emergency admission for medial personnel by unknown HIV-positive patient status?]

In the trauma emergency room 212 patients were asked--according to German law--for a blood sample for HIV-testing. Nine (4.2%) victims rejected the test, another 3 (1,4%) did not meet the study criteria since they were previously known to be HIV-positive or suffering from AIDS disease. None of the finally tested 200 patients was HIV-positive. On an anonymous questionnaire that was handed out additionally, 64% of the patients said they would accept HIV-testing without consent prior to operative treatment. 49% would reject HIV-testing without consent in non-operative treatment.

HIV infection in women: immunological markers and the influence of pregnancy

OBJECTIVE

To describe the influence of pregnancy on immunological marker paths and progression of HIV-infected women.

DESIGN

Analysis of prospectively collected immunological and clinical data collected on 145 women reviewed at the City Hospital, Edinburgh, between 1985 and 1992 using a two-level random-effects model that allows for within- and between-patient variance.

RESULTS

There were differences between the marker paths of women according to risk activity; women who had acquired HIV via injecting drug use (in addition to heterosexual intercourse) had a higher level of absolute CD4 cells, CD4% and total lymphocytes at seroconversion than those who had acquired HIV via heterosexual intercourse alone; however, immunological markers declined more steeply after seroconversion. There was no evidence that pregnancy, either before or after HIV seroconversion had an adverse effect on marker paths of HIV disease. There was a significant association between pregnancy after HIV seroconversion and post-pregnancy changes in immunological markers: an increase in the CD4% and a decrease in CD8%. However, causality cannot be implied as pregnancy itself may be associated with considerable lifestyle changes. During pregnancy the total white blood count rose due to an increase in the number of granulocytes, whereas the total lymphocyte numbers fell. The absolute CD4 lymphocyte subset counts fell progressively but the effect was due to the fall in the total lymphocyte counts, there being no influence of pregnancy on either CD4% or CD8%.

CONCLUSIONS

In asymptomatic HIV infection, changes in the absolute levels of CD4 and CD8 lymphocyte counts are primarily related to changes in the other components of the white cell count because there were no changes in CD4% and CD8%. Pregnancy itself has no adverse effect on immunological markers of HIV.

Professional HIV risk taking, levels of victimization, and well-being in female prostitutes in The Netherlands

Professional HIV risk taking (nonconsistent condom use with clients) of female prostitutes in The Netherlands is addressed within the context of (early) experiences with abuse, well-being, coping behavior, job satisfaction, and financial need. Data were gathered from 127 female prostitutes on condom use, financial need, and professional attitude, and on experiences with violence and abuse, physical complaints, psychosocial problems, and coping responses. Violent traumatic experiences were found to relate to more severe complaints and problems, and a higher frequency of emotion-focused coping strategies. A risk-taking protection style (as opposed to consistent condom use and selective risk taking) appeared to be associated with more severe experiences with violence, both in childhood and in adult life, with more frequent dissociation as a coping behavior, and with more psychosomatic complaints. Of all the relationships found, more severe experiences with violence on the job were most strongly related to a higher professional HIV risk.

Willingness to work with and sympathy for HIV-positive coworkers: an experimental examination of mode of transmission concern, and knowledge

This study investigated concern about HIV infection, knowledge about HIV/AIDS, and mode of transmission on willingness to work with and sympathy expressed towards a coworker with AIDS. 120 undergraduate students were randomly assigned to one of 12 groups in a 3 x 4 between-subjects design. Subjects viewed one of three 12 min. videotapes, including one videotape designed to increase concern, one designed to increase information, and a control videotape of music. Participants then read one of four scenarios about training a new employee. The scenarios varied the mode of HIV transmission (unknown, heterosexual contact, homosexual contact, or blood transfusion). Analysis showed that the ratings of willingness to work with or sympathy toward the HIV-positive coworker made after the videotape were not higher than those of other groups; however, significantly greater sympathy was reported for coworkers with unknown means of transmission than for coworkers who had contracted the virus through homosexual activity and more sympathy was also shown for coworkers who had contracted AIDS through blood transfusion than for employees who became infected through any type of sexual activity. Findings are discussed in terms of the AIDS literature and suggestions for employers.

Shortened survival in infants vertically infected with human immunodeficiency virus with elevated p24 antigenemia

OBJECTIVE

To determine whether the amount of p24 antigenemia in the first 6 months of life is a predictor of survival in children infected vertically with human immunodeficiency virus type 1.

METHODS

A retrospective study of vertically infected infants and children who were followed prospectively from early infancy and who had quantitation of plasma p24 antigen concentration in the first 6 months of life. Infants were first stratified by duration of survival as infants who died before 2 years of age (short-term survivors) and infants who survived to 2 years of age (intermediate-term survivors). The median p24 antigen concentration and the proportion of infants in each group with high concentrations of antigen were compared. Analyses with and excluding all p24 determinations made after the use of antiretroviral agents were compared Kaplan-Meier product limit analysis was used to compare survival in infants with low and high antigenemia during the first 6 months of life.

RESULTS

The median p24 antigen concentration in 15 short-term survivors was 228 pg/ml, compared with 14 pg/ml in 26 intermediate-term survivors (p < 0.05). The proportion of children with > 100 pg/ml of p24 was higher in short-term than in intermediate-term survivors (p = 0.01). Survival to 2 years of age in infants in whom all p24 antigen values during the first 6 months of life were 100 pg/ml or less was 91%, in comparison with 39% in infants with values greater than 100 pg/ml (p = 0.0017).

CONCLUSIONS

Elevated p24 antigenemia in the first 6 months of life is associated with shorter survival and may be a useful predictor of outcome.

Influence of host genotype on progression to acquired immunodeficiency syndrome among children infected with human immunodeficiency virus type 1

OBJECTIVE

To study the role of host genotype in pediatric infection with human immunodeficiency virus type 1 (HIV-1) and progression to acquired immunodeficiency syndrome (AIDS).

METHODS

Human leukocyte antigen (HLA) class II and complement C4 genotypes were determined by means of molecular genetic techniques for 243 black children born to HIV-1-infected mothers in New York City and San Francisco. Survival, cumulative incidences of opportunistic infections and encephalopathy, and rates of CD4+ T cell decline were compared in children of different genotypes.

RESULTS

Among HIV-1-infected children, the HLA-DR3 haplotype (DRB1*0301-DQA1*0501-DQB1*0201) was associated with increased incidence of encephalopathy, faster rate of CD4+ cell decline, and death before 2 years of age. Deletion of the C4A gene was independently associated with increased incidences of encephalopathy and early death. DPB1*0101 was associated with survival to at least 2 years of age. The presence of DQB1*0604 was associated with increased risk of HIV infection.

CONCLUSIONS

These results are consistent with previously reported associations between HLA genotypes and faster progression to AIDS among HIV-infected adults. The DR3 haplotype and C4A deletion may reflect the same underlying mechanism of susceptibility in that the DR3 haplotype is in linkage disequilibrium with other C4A null alleles. In addition, the class II locus DPB1 may have an independent effect on survival.

Repeat negative human immunodeficiency virus (HIV) testing in San Francisco: magnitude and characteristics

The authors assessed the characteristics of repeat human immunodeficiency virus (HIV) testers at publicly funded sites in San Francisco. During 1992-1993, 31% of all HIV tests were performed on persons testing negative for the third time or more. Persons with greater numbers of prior negative tests were less likely to test HIV-positive. Repeat negative testers were more likely than first-time negative testers to be homosexual or bisexual males, homosexual or bisexual injection drug users (IDUs), or heterosexual IDUs. Repeat testers who seroconverted were more likely to be in these same transmission categories than repeat testers who remained negative. Because of the similarities in risk profile between those most likely to retest and those most likely to seroconvert, attempts to limit repeat testing must proceed cautiously.

Infectious disease marker testing of the autologous blood donor. A case study in clinical ethics

OBJECTIVE

The Food and Drug Administration currently requires written authorization from the patient's physician before autologous units of blood that are positive or reactive for hepatitis B surface antigen or anti-human immunodeficiency virus can be shipped from a site of collection different from the site of transfusion. Additionally, the Blood Products Advisory Committee has recommended the universal testing of all autologous units of blood.

DESIGN

The case of an autologous blood donor with positive infectious disease markers is presented. The ethics of infectious disease testing of patients who preoperatively donate their own blood is discussed.

RESULTS

Many ethical issues are raised by policies requiring infectious disease testing of the autologous blood donor. Blood banking and transfusion medicine specialists should examine the ethical issues raised by regulatory mandates to perform infectious disease testing of the patient who desires to make a preoperative autologous blood donation.

CONCLUSION

A policy that protects the rights of the patient as well as the rights and concerns of health care professionals should be pursued.

AIDS-resembling disease in a non-HIV-infected African born to an HIV-positive mother

We report the case of a 10-month-old boy born to an HIV-positive mother who presented with symptoms compatible with AIDS. However, he became HIV-negative and his condition was probably due to combined cytomegalovirus and Epstein-Barr virus infections.

A nurse's right to refuse a patient care assignment

Ethics is a set of moral principles or values--a guiding philosophy for behavior. Ethical dilemmas in the health care setting occur daily. Perioperative nurse managers need to consider basic ethical principles when resolving these dilemmas, and they must keep in mind that solutions need to serve the best interests of all people involved in given situations. This article discusses criteria by which a nurse can refuse a patient care assignment and those by which a nurse manager can require that a nurse perform a patient care assignment.

HIV infection among female partners of seropositive men in Brazil. Rio de Janeiro Heterosexual Study Group

A heterosexual partner study was carried out in Rio de Janeiro, Brazil, from August 1990 to December 1991. The main objectives were to determine the rate of male-to-female transmission of human immunodeficiency virus (HIV) and to determine risk factors. Male index cases were recruited according to the following criteria: 1) confirmed HIV positivity, 2) 18 years old or older; 3) heterosexual contact within the past year. Only female partners who reported not to have other risk factors but to have had sexual contact with the index case were invited to participate. Couples were interviewed for risk factors and had blood collected for laboratory studies. The overall prevalence of HIV infection was 45 percent among 204 female partners in the study. Using logistic regression, the authors found the following factors to be independently (p < 0.05) associated with HIV infection: 1) anal sex (odds ratio (OR) = 3.74, 95% confidence interval (CI) 1.87-7.45); 2) condom use during vaginal sex sometimes (OR = 1.45, 95% CI 1.07-1.96), rarely (OR = 2.10, 95% CI 1.15-3.83), or never (OR = 3.04, 95% CI 1.23-7.50) as compared with always; 3) frequency of sexual contacts in the year prior to interview (100+) (OR = 2.00, 95% CI 1.03-3.91); and 4) oral contraceptive use (OR = 2.04, 95% CI 0.97-4.29). In addition to a borderline significance of oral contraceptive use, there was a strong suggestion of an interaction with history of sexually transmitted diseases.