"It's better for me to drink, at least the stress is going away": perspectives on alcohol use during pregnancy among South African women attending drinking establishments

The Western Cape of South Africa has one of the highest rates of fetal alcohol spectrum disorders (FASD) globally. Reducing alcohol use during pregnancy is a pressing public health priority for this region, but insight into the experiences of women who drink during pregnancy is lacking. Convenience sampling in alcohol-serving venues was used to identify women who were currently pregnant (n = 12) or recently post-partum (n = 12) and reported drinking during the pregnancy period. In-depth qualitative interviews were conducted between April and August 2013. Interviews explored drinking narratives, with textual data analyzed for themes related to factors that contributed to drinking during pregnancy. All but one woman reported her pregnancy as unplanned. The majority sustained or increased drinking after pregnancy recognition, with patterns typically including multiple days of binge drinking per week. Analysis of the textual data revealed five primary factors that contributed to drinking during pregnancy: 1) women used alcohol as a strategy to cope with stressors and negative emotions, including those associated with pregnancy; 2) women drank as a way to retain social connection, often during a difficult period of life transition; 3) social norms in women's peer groups supported drinking during pregnancy; 4) women lacked attachment to the pregnancy or were resistant to motherhood; and 5) women were driven physiologically by alcohol addiction. Our data suggest that alcohol-serving settings are important sites to identify and target women at risk of drinking during pregnancy. Intervention approaches to reduce alcohol use during pregnancy should include counseling and contraception to prevent unwanted pregnancies, mental health and coping interventions targeting pregnant women, peer-based interventions to change norms around perinatal drinking, and treatment for alcohol dependence during pregnancy. Our findings suggest that innovative interventions that go beyond the boundaries of the health care system are urgently needed to address FASD in this region.

Food insecurity and alcohol use among pregnant women at alcohol-serving establishments in South Africa

South Africa has the highest rate of fetal alcohol syndrome (FAS) in the world. While efforts have been made to curb the high rate of FAS, little is known about situational factors that may contribute to alcohol use during pregnancy. In the current paper, we focus on the role of food insecurity and its relationship to alcohol use among pregnant women. Women completed computer-assisted interviews. Generalized linear modeling was used in all analyses. Women attending alcohol-serving establishments in a township in Cape Town, South Africa were recruited for the study. Five hundred sixty women were sampled and 95 women reported being pregnant. High levels of alcohol use were reported among pregnant women: 65 % of women consumed alcohol at least every month and 29 % consumed alcohol as often as two to three times per week. Thirty-four percent of the women reported having six or more drinks per occasion on at least a weekly basis. The majority (87 %) of pregnant women reported experiencing some form of food insecurity (e.g., food unavailable, eating less) in the past month. Alcohol use was significantly associated with food insecurity, even when controlling for relevant demographic variables. Intervention with pregnant women who consume alcohol is urgently needed. Future research should focus on understanding the intersection of food insecurity and alcohol, and how the experience of food insecurity may contribute to greater rates of alcohol use and abuse among pregnant women.

Co-occurring psychosocial problems and HIV risk among women attending drinking venues in a South African township: a syndemic approach

BACKGROUND

In South Africa, women comprise the majority of HIV infections. Syndemics, or co-occurring epidemics and risk factors, have been applied in understanding HIV risk among marginalized groups.

PURPOSE

The purposes of this study are to apply the syndemic framework to examine psychosocial problems that co-occur among women attending drinking venues in South Africa and to test how the co-occurrence of these problems may exacerbate risk for HIV infection.

METHOD

Five hundred sixty women from a Cape Town township provided data on multiple psychosocial problems, including food insufficiency, depression, abuse experiences, problem drinking, and sexual behaviors.

RESULTS

Bivariate associations among the syndemic factors showed a high degree of co-occurrence and regression analyses showed an additive effect of psychosocial problems on HIV risk behaviors.

CONCLUSIONS

These results demonstrate the utility of a syndemic framework to understand co-occurring psychosocial problems among women in South Africa. HIV prevention interventions should consider the compounding effects of psychosocial problems among women.

Setting the bar high or setting up to fail? Interpretations and implications of the EXPLORE Study (HPTN 015)

Controlled studies show that HIV risk reduction counseling significantly increases condom use, reduces unprotected sex and prevents sexually transmitted infections. Nevertheless, without evidence of reducing HIV incidence, these interventions are generally discarded. One trial, the EXPLORE study, was designed to test whether ten sessions of risk reduction counseling could impact HIV incidence among men who have sex with men in six US cities. Based on epidemiologic models to define effective HIV vaccines, a 35 % reduction in HIV incidence was set a priori as the benchmark of success in this behavioral intervention trial. Results demonstrated a significant effect of the intervention, with more than a 35 % reduction in HIV incidence observed during the initial 12-18 months following counseling. Over an unprecedented 48-month follow-up, however, the effect of counseling on HIV incidence declined to 18 %. The current review examined how the scientific literature has thus far judged the outcomes of the EXPLORE study as well as the policy implications of these judgments. We identified 127 articles that cited the EXPLORE study since its publication. Among articles that discuss the HIV incidence outcomes, 20 % judged the intervention effective and 80 % judged the intervention ineffective. The overwhelmingly negative interpretation of the EXPLORE study outcomes is reflected in public policies and prevention planning. We conclude that using a vaccine standard to define success led to a broad discrediting of the benefits of behavioral counseling and, ultimately, adversely impacted policies critical to the field of HIV prevention.

Drinking before and after pregnancy recognition among South African women: the moderating role of traumatic experiences

BACKGROUND

South Africa has one of the world's highest rates of fetal alcohol spectrum disorder (FASD) and interpersonal trauma. These co-occurring public health problems raise the need to understand alcohol consumption among trauma-exposed pregnant women in this setting. Since a known predictor of drinking during pregnancy is drinking behavior before pregnancy, this study explored the relationship between women's drinking levels before and after pregnancy recognition, and whether traumatic experiences - childhood abuse or recent intimate partner violence (IPV) - moderated this relationship.

METHODS

Women with incident pregnancies (N = 66) were identified from a longitudinal cohort of 560 female drinkers in a township of Cape Town, South Africa. Participants were included if they reported no pregnancy at one assessment and then reported pregnancy four months later at the next assessment. Alcohol use was measured by the Alcohol Use Disorders Identification Test (AUDIT), and traumatic experiences of childhood abuse and recent IPV were also assessed. Hierarchical linear regressions controlling for race and age examined childhood abuse and recent IPV as moderators of the effect of pre-pregnancy recognition drinking on post-pregnancy recognition AUDIT scores.

RESULTS

Following pregnancy recognition, 73% of women reported drinking at hazardous levels (AUDIT ≥ 8). Sixty-four percent reported early and/or recent exposure to trauma. While drinking levels before pregnancy significantly predicted drinking levels after pregnancy recognition, t(64) = 3.50, p < .01, this relationship was moderated by experiences of childhood abuse, B = -.577, t(60) = -2.58, p = .01, and recent IPV, B = -.477, t(60) = -2.16, p = .04. Pregnant women without traumatic experiences reported drinking at levels consistent with levels before pregnancy recognition. However, women with traumatic experiences tended to report elevated AUDIT scores following pregnancy recognition, even if low-risk drinkers previously.

CONCLUSION

This study explored how female drinkers in South Africa may differentially modulate their drinking patterns upon pregnancy recognition, depending on trauma history. Our results suggest that women with traumatic experiences are more likely to exhibit risky alcohol consumption when they become pregnant, regardless of prior risk. These findings illuminate the relevance of trauma-informed efforts to reduce FASD in South Africa.

Psychosocial factors related to willingness to use pre-exposure prophylaxis for HIV prevention among Black men who have sex with men attending a community event

Objectives In the US, Black men who have sex with men (BMSM) are disproportionately affected by HIV/AIDS. Pre-exposure prophylaxis (PrEP) holds tremendous promise for curbing the HIV/AIDS epidemic among these men. However, many psychosocial components must be addressed in order to implement this prevention tool effectively among BMSM.

METHODS

We assessed PrEP knowledge and use, health care access experiences, race-based medical mistrust, sexual partners and behaviours, and drug and alcohol use among 699 men attending a community event in the south-eastern United States. We used generalised linear modelling to assess factors associated with their willingness to use PrEP.

RESULTS

Three hundred and ninety-eight men reported being BMSM and having HIV-negative status. Among these men, 60% reported being willing to use PrEP. Lack of being comfortable with talking to a health care provider about having sex with men, not having discussed having sex with a man with a health care provider, race-based medical mistrust, and alcohol consumption and substance use were all identified as barriers to willingness to use PrEP. Sexual risk-taking, number of sex partners and STI diagnosis were not associated with willingness to use PrEP.

CONCLUSIONS

Findings from the current paper demonstrate the importance of acknowledging the role of various psychosocial factors in the uptake of PrEP. It is imperative that we prioritise research into understanding these barriers better, as the failure to do so will impede the tremendous potential of this prevention technology.

Men who report recent male and female sex partners in Cape Town, South Africa: an understudied and underserved population

The HIV/AIDS epidemic in South Africa has largely focused on the needs of heterosexual men and women. However, little is known about the sexual risk histories of men who have sex with both men and women (MSMW). Furthermore, we know very little about the psychosocial health needs or of the possibility of a syndemic (numerous interrelated epidemics) among MSMW. We surveyed 1,203 men attending drinking establishments in a township located in Cape Town, South Africa. We compared the behaviors and experiences of MSMW to men reporting only having sex with women (MSW). Twelve percent of the sample reported having sex with both men and women in the past 4 months. MSMW were twice as likely as MSW to report being HIV positive (10.5 vs. 4.6 %). MSW were more likely to be married than MSMW but reported similar numbers of female sex partners. MSMW were more likely to report a history of childhood sexual abuse, recent experienced and perpetrated physical and sexual partner violence, both receiving and giving sex for money, drugs, or shelter, and a recent STI. These factors were found to be interrelated among MSW but not MSMW. Although MSMW demonstrate considerable risk taking and report higher rates of HIV infection than MSW, their needs are largely unmet and underemphasized. Findings suggest the need to better understand factors contributing to sexual risk taking among MSMW. HIV prevention interventions should consider psychosocial health problems unique to MSMW residing in South African townships.

A reanalysis of a behavioral intervention to prevent incident HIV infections: including indirect effects in modeling outcomes of Project EXPLORE

Project EXPLORE - a large-scale, behavioral intervention tested among men who have sex with men (MSM) at-risk for HIV infection - was generally deemed as ineffective in reducing HIV incidence. Using novel and more precise data analytic techniques we reanalyzed Project EXPLORE by including both direct and indirect paths of intervention effects. Data from 4296 HIV-negative MSM who participated in Project EXPLORE, which included 10 sessions of behavioral risk reduction counseling completed from 1999 to 2005, were included in the analysis. We reanalyzed the data to include parameters that estimate the over-time effects of the intervention on unprotected anal (UA) sex and the over-time effects of the intervention on HIV status mediated by UA sex simultaneously in a single model. We found the indirect effect of intervention on HIV infection through UA sex to be statistically significant up through 12-month post-intervention, OR = 0.83, 95% CI = 0.72-0.95. Furthermore, the intervention significantly reduced UA sex up through 18-month post-intervention, OR = 0.79, 95% CI = 0.63-0.99. Our results reveal effects not tested in the original model that offer new insight into the effectiveness of a behavioral intervention for reducing HIV incidence. Project EXPLORE demonstrated that when tested against an evidence-based, effective control condition can result in reductions in rates of HIV acquisition at one year follow-up. Findings highlight the critical role of addressing behavioral risk reduction counseling in HIV prevention.

Condom negotiation, HIV testing, and HIV risks among women from alcohol serving venues in Cape Town, South Africa

BACKGROUND

Women in South Africa are at particularly high-risk for HIV infection and are dependent on their male partners' use of condoms for sexual risk reduction. However, many women are afraid to discuss condoms with male partners, placing them at higher risk of HIV infection.

PURPOSE

To examine the association between fear of condom negotiation with HIV testing and transmission risk behaviors, including alcohol use and sexual risks among South African women.

METHOD

Women (N = 1333) residing in a primarily Xhosa-speaking African township in Cape Town and attending informal alcohol-serving venues (shebeens) completed anonymous surveys. Logistic regression was used to test the hypothesis that fear of condom negotiation would be associated with increased risk for HIV.

RESULTS

Compared to women who did not fear condom negotiation, those who did were significantly less likely to have been tested for HIV, were more likely to have experienced relationship abuse, and to report more alcohol use and more unprotected sex.

CONCLUSIONS

For women in South Africa, fear of condom negotiation is related to higher risk of HIV. HIV prevention efforts, including targeted HIV counseling and testing, must directly address gender issues.

Meta-analysis of single-session behavioral interventions to prevent sexually transmitted infections: implications for bundling prevention packages

Evidence-based, single-session behavioral interventions are urgently needed for preventing the spread of HIV and other sexually transmitted infections (STIs). To estimate the efficacy of single-session, behavioral interventions for STI prevention, we collected data from 29 single-session interventions (20 studies; n = 52 465) with an STI outcome. Infection with an STI was 35% less likely (odds ratio = 0.65; 95% confidence interval = 0.55-0.77) among intervention group participants than among control group participants. Single-session interventions offer considerable benefits in terms of disease prevention and create minimal burden for both the patient and the provider. Brief and effective STI prevention interventions are a valuable tool and can be readily adapted to bolster the benefits of biomedical technologies focusing on the prevention of HIV and other STIs.

The relationship between pornography use and sexual behaviours among at-risk HIV-negative men who have sex with men

OBJECTIVES

Although pornography is widely available and frequently used among many adults in the USA, little is known about the relationship between pornography and risk factors for HIV transmission among men who have sex with men.

METHODS

Baseline assessments from a behavioural intervention trial for at-risk men who have sex with men were conducted in Atlanta, GA in 2009. Univariate and multivariate generalised linear models were used to assess the relationships between known risk factors for HIV infection, time spent viewing pornography, and sex behaviours.

RESULTS

One hundred forty-nine men reporting HIV-negative status and two or more unprotected anal sex partners in the past 6 months were enrolled in an intervention trial and completed survey assessments. Time spent viewing pornography was significantly associated with having more male sexual partners (B=0.45, SE=0.04, P<0.001) and unprotected insertive anal sex acts (B=0.28, SE=0.04, P<0.001). Moreover, increased substance use (drug use, B=0.61, SE=0.14, P<0.001; alcohol use, B=0.03, SE=0.01, P<0.01) and decreased perception of risk for HIV infection (B=-0.09, SE=0.04, P<0.05) were found to be significantly associated with greater time spent viewing pornography.

CONCLUSIONS

This exploratory study is novel in that it sheds light on the associations between viewing pornography and sexual risk taking for HIV infection. Future studies in this area should focus on understanding how the content of pornography; in particular, the viewing of unprotected and protected sex acts, may affect sexual risk taking behaviour.

Gender-based violence and HIV sexual risk behavior: alcohol use and mental health problems as mediators among women in drinking venues, Cape Town

Gender-based violence is a key determinant of HIV infection among women in South Africa as elsewhere. However, research has not examined potential mediating processes to explain the link between experiencing abuse and engaging in HIV sexual risk behavior. Previous studies suggest that alcohol use and mental health problems may explain how gender-based violence predicts sexual risk. In a prospective study, we examined whether lifetime history of gender-based violence indirectly affects future sexual risk behavior through alcohol use, depression and post-traumatic stress disorder (PTSD) in a high-risk socio-environmental context. We recruited a cohort of 560 women from alcohol drinking venues in a Cape Town, South African township. Participants completed computerized interviews at baseline and 4 months later. We tested prospective mediating associations between gender-based violence, alcohol use, depression, PTSD, and sexual risk behavior. There was a significant indirect effect of gender-based violence on sexual risk behavior through alcohol use, but not mental health problems. Women who were physically and sexually abused drank more, which in turn predicted more unprotected sex. We did not find a mediated relationship between alcohol use and sexual risk behavior through the experience of recent abuse or mental health problems. Alcohol use explains the link between gender-based violence and sexual risk behavior among women attending drinking venues in Cape Town, South Africa. Efforts to reduce HIV risk in South Africa by addressing gender-based violence must also address alcohol use.

Pregnancy, alcohol intake, and intimate partner violence among men and women attending drinking establishments in a Cape Town, South Africa township

The highest rates of fetal alcohol syndrome worldwide can be found in South Africa. Particularly in impoverished townships in the Western Cape, pregnant women live in environments where alcohol intake during pregnancy has become normalized and interpersonal violence (IPV) is reported at high rates. For the current study we sought to examine how pregnancy, for both men and women, is related to alcohol use behaviors and IPV. We surveyed 2,120 men and women attending drinking establishments in a township located in the Western Cape of South Africa. Among women 13.3% reported being pregnant, and among men 12.0% reported their partner pregnant. For pregnant women, 61% reported attending the bar that evening to drink alcohol and 26% reported both alcohol use and currently experiencing IPV. Daily or almost daily binge drinking was reported twice as often among pregnant women than non-pregnant women (8.4% vs. 4.2%). Men with pregnant partners reported the highest rates of hitting sex partners, forcing a partner to have sex, and being forced to have sex. High rates of alcohol frequency, consumption, binge drinking, consumption and binge drinking were reported across the entire sample. In general, experiencing and perpetrating IPV were associated with alcohol use among all participants except for men with pregnant partners. Alcohol use among pregnant women attending shebeens is alarmingly high. Moreover, alcohol use appears to be an important factor in understanding the relationship between IPV and pregnancy. Intensive, targeted, and effective interventions for both men and women are urgently needed to address high rates of drinking alcohol among pregnant women who attend drinking establishments.

Gender-based violence, alcohol use, and sexual risk among female patrons of drinking venues in Cape Town, South Africa

Gender-based violence is a well-recognized risk factor for HIV infection among women. Alcohol use is associated with both gender-based violence and sexual risk behavior, but has not been examined as a correlate of both in a context of both high HIV risk and hazardous drinking. The purpose of this paper is to examine the association between recent abuse by a sex partner with alcohol and sexual risk behavior among female patrons of alcohol serving venues in South Africa. Specifically, the aim of this study is to determine whether sexual risk behaviors are associated with gender-based violence after controlling for levels of alcohol use. We surveyed 1,388 women attending informal drinking establishments in Cape Town, South Africa to assess recent history of gender-based violence, drinking, and sexual risk behaviors. Gender-based violence was associated with both drinking and sexual risk behaviors after controlling for demographics among the women. A hierarchical logistic regression analysis showed that after controlling for alcohol use sexual risk behavior remained significantly associated with gender-based violence, particularly with meeting a new sex partner at the bar, recent STI diagnosis, and engaging in transactional sex, but not protected intercourse or number of partners. In South Africa where heavy drinking is prevalent women may be at particular risk of physical abuse from intimate partners as well as higher sexual risk. Interventions that aim to reduce gender-based violence and sexual risk behaviors must directly work to reduce drinking behavior.

The influence of male circumcision for HIV prevention on sexual behaviour among traditionally circumcised men in Cape Town, South Africa

We examined the relationship between HIV prevention beliefs related to male circumcision and sexual behaviour/sexually transmitted infection (STI) acquisition among traditionally circumcised men in Cape Town, South Africa. HIV-negative men (n = 304), circumcised for cultural/religious reasons, attending a health clinic in Cape Town, South Africa, completed cross-sectional surveys. Generalized linear models were used to analyse the relationships between unprotected vaginal sex acts, number of female sexual partners, STI diagnoses and male circumcision-related beliefs and risk perceptions. Men who were aware that circumcision offers protection against HIV (relative risk [RR] = 1.19, 95% confidence interval [CI] = 1.06-1.32, P < 0.01), endorsed risk compensation related to male circumcision (RR = 1.15, 95% CI = 1.11-1.12, P < 0.01) and perceived lower risk of HIV infection when circumcised (RR = 1.08, 95% CI = 1.04-1.12, P < 0.01) were more likely to report unprotected vaginal sex acts. Similar patterns were also identified when predicting number of female sexual partners. Men who were more likely to endorse risk compensation related to male circumcision were also more likely to be diagnosed with a chronic STI (odds ratio [OR] = 1.64, 95% CI = 1.06-2.53, P < 0.05). Our findings suggest that we must not overlook the effects of beliefs towards male circumcision for HIV prevention among men traditionally circumcised; doing so may undermine current efforts to reduce HIV transmission through male circumcision.

A novel approach to prevention for at-risk HIV-negative men who have sex with men: creating a teachable moment to promote informed sexual decision-making

OBJECTIVES

As a result of the impact of HIV among men who have sex with men (MSM), multiple strategies for reducing HIV risks have emerged from within the gay community. One common HIV risk reduction strategy limits unprotected sex partners to those who are of the same HIV status (serosorting). We tested a novel, brief, one-on-one intervention, based on informed decision-making and delivered by peer counselors, designed to address the limitations of serosorting (e.g., risk for HIV transmission).

METHODS

In 2009, we recruited a group of 149 at-risk men living in Atlanta, Georgia, and randomly assigned them to an intervention condition addressing serosorting or a standard-of-care control condition.

RESULTS

Men in the serosorting intervention reported fewer sexual partners (Wald χ(2) = 8.79, P < .01) at the study follow-ups. Behavioral results were also consistent with changes in psychosocial variables, including condom use self-efficacy and perceptions of risk for HIV transmission.

CONCLUSIONS

With the current intervention, service providers can offer risk reduction for men arguably at the highest risk for HIV infection in the United States. Addressing risks associated with serosorting in a feasible, low-cost intervention has the potential to significantly affect the HIV epidemic.

A strategy for selecting sexual partners believed to pose little/no risks for HIV: serosorting and its implications for HIV transmission

A common HIV/AIDS risk reduction strategy among men who have sex with men (MSM) is to limit their unprotected sex partners to those who are of the same HIV status, a practice referred to as serosorting. Decisions to serosort for HIV risk reduction are based on personal impressions and beliefs, and there is limited guidance offered on this community derived strategy from public health services. This paper reviews research on serosorting for HIV risk reduction and offers an evidence-based approach to serosorting guidance. Following a comprehensive electronic and manual literature search, we reviewed 51 studies relating to the implications of serosorting. Studies showed that HIV negative MSM who select partners based on HIV status are inadvertently placing themselves at risk for HIV. Infrequent HIV testing, lack of HIV status disclosure, co-occurring sexually transmitted infections, and acute HIV infection impede the potential protective benefits of serosorting. Public health messages should continue to encourage reductions in numbers of sexual partners and increases in condom use. Risk reduction messages should also highlight the limitations of relying on one's own and partner's HIV status in making sexual risk decisions.

Sexual partner selection and HIV risk reduction among Black and White men who have sex with men

OBJECTIVES

We examined differences in sexual partner selection between Black and White men who have sex with men (MSM) to better understand how HIV status of participants' sexual partners and related psychosocial measures influence risk taking among these men.

METHODS

We collected cross-sectional surveys from self-reported HIV-negative Black MSM and White MSM attending a gay pride festival in Atlanta, Georgia.

RESULTS

HIV-negative White MSM were more likely than were HIV-negative Black MSM to report having unprotected anal intercourse with HIV-negative men, and HIV-negative Black MSM were more likely than were HIV-negative White MSM to report having unprotected anal intercourse with HIV status unknown partners. Furthermore, White MSM were more likely to endorse serosorting (limiting unprotected partners to those who have the same HIV status) beliefs and favorable HIV disclosure beliefs than were Black MSM.

CONCLUSIONS

White MSM appear to use sexual partner-related risk reduction strategies to reduce the likelihood of HIV infection more than do Black MSM. Partner selection strategies have serious limitations; however, they may explain in part the disproportionate number of HIV infections among Black MSM.

HIV transmission risk among HIV seroconcordant and serodiscordant couples: dyadic processes of partner selection

Selecting sex partners of the same HIV status or serosorting is a sexual risk reduction strategy used by many men who have sex with men. However, the effectiveness of serosorting for protection against HIV is potentially limited. We sought to examine how men perceive the protective benefits of factors related to serosorting including beliefs about engaging in serosorting, sexual communication, and perceptions of risk for HIV. Participants were 94 HIV negative seroconcordant (same HIV status) couples, 20 HIV serodiscordant (discrepant HIV status) couples, and 13 HIV positive seroconcordant (same HIV status) couples recruited from a large gay pride festival in the southeastern US. To account for nonindependence found in the couple-level data, we used multilevel modeling which includes dyad in the analysis. Findings demonstrated that participants in seroconcordant relationships were more likely to believe that serosorting reduces concerns for condom use. HIV negative participants in seroconcordant relationships viewed themselves at relatively low risk for HIV transmission even though monogamy within relationships and HIV testing were infrequent. Dyadic analyses demonstrated that partners have a substantial effect on an individual's beliefs and number of unprotected sex partners. We conclude that relationship partners are an important source of influence and, thus, intervening with partners is necessary to reduce HIV transmission risks.

On holiday: a risk behavior profile for men who have vacationed at gay resorts

Sexual risk behavior is higher when people vacation as compared to when they are at home. The current study uses survey data to compare sexual risk behavior of gay men who vacation at gay resorts to those who do not. Independent predictors of vacationing at gay resorts included income level, relationship status, ever having attended a circuit party, and HIV serostatus. For men who visit resorts to meet sex partners, independent predictors included relationship status, ever having attended a circuit party, HIV serostatus, number of male sex partners in the past six months, and number of anal insertive male partners using a condom. These results show a need for the development of structural interventions in the gay resort and hotel setting.

Serosorting sexual partners and risk for HIV among men who have sex with men

OBJECTIVE

The purpose of the current study was to assess whether men who have sex with men (MSM) who limit their unprotected anal sexual partners to those who are of the same HIV status (serosort) differ in their risk for HIV transmission than MSM who do not serosort.

METHODS

Cross-sectional surveys administered at a large Gay Pride festival in June 2006 (80% response rate) were collected from MSM. Univariate and multivariate logistic regressions were used to identify predictors of serosorting. Analyses were conducted in 2006.

RESULTS

Participants were self-identified as HIV-negative MSM (N=628); about one third of them engaged in serosorting (n=229). Men who serosort were more likely to believe that it offered protection against HIV transmission, perceived themselves as being at no relatively higher risk for HIV transmission, and had more unprotected anal intercourse partners. Over half the sample reported their frequency of HIV testing as yearly or less frequently; this finding did not differ between serosorters and nonserosorters.

CONCLUSIONS

Men who identify as HIV-negative and serosort are no more likely to know their HIV status than men who do not serosort and are at higher risk for exposure to HIV. Interventions targeting MSM must address the limitations of serosorting.

Non-Hodgkin's lymphoma mimicking gynecological malignancies of the vagina and cervix: a report of four cases

Although in the past two decades there has been a sharp rise in the incidence of extranodal primary lymphomas in the United States, non-Hodgkin's lymphoma (NHL) of the female genital tract is still rare. We present four cases of extranodal NHL presenting with signs and symptoms consistent with cancer of the vagina or cervix and lacking the “B” symptoms often associated with systemic lymphoma such as fever, weight loss, night sweat, and fatigue. It is important for gynecologists to be aware of this neoplastic disease and to include cervical or vaginal lymphoma in the differential diagnosis of patients presenting with examinations suggestive of cervical or vaginal cancer. A correct diagnosis leads to the appropriate therapy, and radical gynecological surgery can be avoided for primary cervical and vaginal lymphoma

Hypomania induced by herbal and pharmaceutical psychotropic medicines following mild traumatic brain injury

The use of herbal medicines has become a very common practice. While many are safe enough to be available over-the-counter, they may pose risks due to interactions with pharmaceutical medications and effects in specific clinical populations. The case of a female patient with a history of mild traumatic brain injury and resulting depression is presented. She experienced hypomania after adding St John's wort and Ginkgo biloba to her regimen of fluoxetine and buspirone, which remitted after discontinuation of the herbal medicines. Implications for interactions between various psychopharmacologic agents, including herbal medicines and selective serotonin reuptake inhibitors (SSRIs), as well as the need for appropriate patient and health care provider education are discussed.

Multiple fregoli delusions after traumatic brain injury

A 61 year old man after a traumatic brain injury resulting in right frontal and left temporoparietal contusions developed florid Fregoli-type misidentifications. Extensive neuropsychological testing demonstrated significant deficits in executive and memory functions. The patient's neuropsychological profile closely resembled that seen in previously reported patients with Capgras syndrome. Our findings are consistent with the hypothesis that a combination of executive and memory deficits may account for cases of delusional misidentification associated with brain lesions. However, the form which the delusion takes may be influenced by other factors including motivation.

Malignant mixed Müllerian tumor with rhabdoid features: a report of two cases and a review of the literature

Rhabdoid tumors were originally described as a type of pediatric renal neoplasm that contains cells resembling rhabdomyoblasts but lacking muscle differentiation. Extrarenal rhabdoid tumors have since been reported in multiple anatomic sites in the pediatric and adult population. These tumors are characterized by an aggressive clinical course, resistance to treatment, and a rapidly fatal outcome. Eight cases of uterine neoplasms with rhabdoid differentiation have been previously reported. In the three cases where clinical follow-up was available, the patients died of disease within 3 to 17 months after the diagnosis was established. We report two cases of uterine malignant mixed Müllerian tumor (carcinosarcoma) with rhabdoid differentiation. The findings and clinical outcome confirm the aggressive nature of uterine tumors with rhabdoid differentiation. One of the patients died of disease 3 months after initial operative treatment while the other patient's tumor recurred in 1 month and she died within 10 weeks. The poor prognosis of these neoplasms makes their histopathologic recognition important.

Glycoprotein Ib bioassays. Activity levels in Bernard-Soulier syndrome and in stored blood bank platelets

Glycoprotein Ib (GP-Ib) is a major platelet receptor protein concerned with von Willebrand-factor binding, platelet agglutination, and platelet adhesion, and it is required for normal hemostasis. By the use of botrocetin (venom coagglutinin), both quantitative and semiquantitative assays for GP-Ib activity were developed. The latter assay uses limiting dilutions of botrocetin as a measure of GP-Ib activity. Platelets, stored up to 23 days under blood bank conditions, were assayed by the limiting dilution test. Values of GP-Ib were progressively diminished after 9 to 10 days of storage, reaching levels of less than 10% at 23 days. Platelets from a subject with Bernard-Soulier syndrome showed less than 10% GP-Ib activity. These assays appear to be a specific measure of functional GP-Ib activity, and, when combined with GP-Ib antigen measurement by other methods, they provide a means for further characterizing GP-Ib abnormalities.

Hemorrhagic colitis and pseudomelanosis coli in ipecac ingestion by proxy

This report describes a toddler with chronic diarrhea, vomiting, and hypotonia due to surreptitious administration of syrup of ipecac by his mother (Munchausen's syndrome by proxy). Several features of this case distinguish it from previous reports of chronic ipecac ingestion in childhood: the development of grossly bloody stools; radiologic, endoscopic, and biopsy evidence of a chronic moderate colitis resembling ulcerative colitis; and the histologic finding of pseudomelanosis coli, providing an important clue to toxic ingestion. The significance and possible mechanism for genesis of pseudomelanosis coli is discussed. This case emphasizes the variability in presentation and difficulty in diagnosing long-term ipecac ingestion by proxy. Ipecac toxicity should be considered in children with unexplained colitis and vomiting.

Downhill ski fatalities: the Vermont experience

All ski-related accidental deaths in Vermont during the 1979-1980 through 1985-1986 ski seasons are reported. Sixteen deaths occurred in downhill skiers at major ski areas. During the same period 24.17 million skier-days were logged for an estimated rate of one death per 1.5 million skier-days. Of the skiers 81% were male, and 62% were between the ages of 15 and 26 years. Fourteen of 16 cases resulted from collisions with objects, most commonly trees. The predominance of head and upper body injuries was striking, and fractures of the lower extremities were uncommon. Lethal head/neck injuries accounted for all but two of the deaths. Only one skier was wearing a helmet. Speed and loss of control were the two major contributing factors identified in these accidents. The need for research and development in the prevention of this class of ski accidents is emphasized.