101
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Woodhall SC, Soldan K, Sonnenberg P, Mercer CH, Clifton S, Saunders P, da Silva F, Alexander S, Wellings K, Tanton C, Field N, Copas AJ, Ison CA, Johnson AM. Is chlamydia screening and testing in Britain reaching young adults at risk of infection? Findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Sex Transm Infect 2015; 92:218-27. [PMID: 26290483 PMCID: PMC4853535 DOI: 10.1136/sextrans-2015-052013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 07/12/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In the context of widespread opportunistic chlamydia screening among young adults, we aimed to quantify chlamydia testing and diagnosis among 16-24 year olds in Britain in relation to risk factors for prevalent chlamydia infection. METHODS Using data from sexually experienced (≥1 lifetime sexual partner) 16-year-old to 24-year-old participants in Britain's third National Survey of Sexual Attitudes and Lifestyles (conducted 2010-2012), we explored socio-demographic and behavioural factors associated with prevalent chlamydia infection (detected in urine; n=1832), self-reported testing and self-reported diagnosis in the last year (both n=3115). RESULTS Chlamydia prevalence was 3.1% (95% CI 2.2% to 4.3%) in women and 2.3% (1.5% to 3.4%) in men. A total of 12.3% of women and 5.3% men had a previous chlamydia diagnosis. Factors associated with prevalent infection were also associated with testing and diagnosis (eg, increasing numbers of sexual partners), with some exceptions. For example, chlamydia prevalence was higher in women living in more deprived areas, whereas testing was not. In men, prevalence was higher in 20-24 than 16-19 year olds but testing was lower. Thirty per cent of women and 53.7% of men with ≥2 new sexual partners in the last year had not recently tested. CONCLUSIONS In 2010-2012 in Britain, the proportion of young adults reporting chlamydia testing was generally higher in those reporting factors associated with chlamydia. However, many of those with risk factors had not been recently tested, leaving potential for undiagnosed infections. Greater screening and prevention efforts among individuals in deprived areas and those reporting risk factors for chlamydia may reduce undiagnosed prevalence and transmission.
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Affiliation(s)
- Sarah C Woodhall
- Research Department of Infection and Population Health, University College London, London, UK Centre for Infectious Disease Surveillance & Control (CIDSC), Public Health England, London, UK
| | - Kate Soldan
- Centre for Infectious Disease Surveillance & Control (CIDSC), Public Health England, London, UK
| | - Pam Sonnenberg
- Research Department of Infection and Population Health, University College London, London, UK
| | - Catherine H Mercer
- Research Department of Infection and Population Health, University College London, London, UK
| | - Soazig Clifton
- Research Department of Infection and Population Health, University College London, London, UK NatCen Social Research, London, UK
| | | | | | | | - Kaye Wellings
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Clare Tanton
- Research Department of Infection and Population Health, University College London, London, UK
| | - Nigel Field
- Research Department of Infection and Population Health, University College London, London, UK
| | - Andrew J Copas
- Research Department of Infection and Population Health, University College London, London, UK
| | | | - Anne M Johnson
- Research Department of Infection and Population Health, University College London, London, UK
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102
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Roderick P, S Sundaram S, Dimitrov BD, Dewhirst S, Tucker LJ, Leydon G, Sheron N, Frater A, Harindra V. Assessing feasibility and acceptability of a brief intervention for risky alcohol consumption in sexual health clinic attendees: a randomised controlled trial. ACTA ACUST UNITED AC 2015; 42:143-51. [PMID: 26259896 DOI: 10.1136/jfprhc-2014-100912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 07/01/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the feasibility and acceptability of screening attendees at a sexual health clinic (SHC) for alcohol misuse, and delivering a brief intervention (BI). To explore the effect of this BI on drinking and sexual behaviour. METHODS A consecutive sample of consenting SHC attendees aged ≥16 years were screened using Alcohol Use Disorders Identification Test Consumption (AUDIT-C). Men scoring ≥5 and women scoring ≥4 were invited to complete the full AUDIT, alcohol diary and baseline questionnaire. INTERVENTIONS Participants were randomised to receive BI by a trained sexual health professional or a standard alcohol leaflet (usual care, UC). All were followed up for changes in alcohol and sexual behaviour at 6 weeks and 6 months. A fidelity check and staff focus group were undertaken. RESULTS Of 664 participants screened, 215 (32%) were eligible for randomisation and 207 were included in the final analysis: 103 (BI) and 104 (UC). Follow-up rates were 54% and 47% at 6 weeks and 6 months, respectively. Both groups reduced alcohol consumption though the degree of change did not differ between them. There was some evidence of positive changes in sexual health risk in both groups. BI was delivered as intended, adding 5 minutes to the consultation, and staff feedback was positive. CONCLUSIONS Alcohol misuse was common in SHC attendees. Systematic assessment and BI for alcohol misuse was feasible and acceptable to staff and patients. Identification and provision of standard information alone appeared to influence drinking and sexual behaviour. TRIAL REGISTRATION NUMBER ISRCTN19452424.
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Affiliation(s)
- Paul Roderick
- Academic Unit of Primary Care & Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Borislav D Dimitrov
- Academic Unit of Primary Care & Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Susan Dewhirst
- Academic Unit of Primary Care & Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Geraldine Leydon
- Academic Unit of Primary Care & Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nick Sheron
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Alison Frater
- South Central Strategic Health Authority, Reading, UK
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103
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Dir AL, Cyders MA. Risks, Risk Factors, and Outcomes Associated with Phone and Internet Sexting Among University Students in the United States. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:1675-84. [PMID: 25358950 PMCID: PMC6834346 DOI: 10.1007/s10508-014-0370-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 05/10/2013] [Accepted: 06/21/2014] [Indexed: 05/10/2023]
Abstract
Sexting, defined as the exchange of sexually suggestive pictures or messages via mobile phone or social networking sites (SNS), has received media attention for its prevalence and associated negative outcomes; however, research has not yet fully established risk factors for and resulting outcomes from sexting behaviors. The current study was the first empirical test of a causal path model in males and females, in which impulsivity-related traits and expectancies influence sexual behaviors through phone and SNS sexting. We also examined prevalence and perceived likelihood of common negative outcomes associated with sexting. Multiple regression and structural equation modeling (SEM) statistics were conducted on two independent undergraduate samples (n = 611 and 255). The best fitting SEM model (RMSEA = 0.04, CFI = 0.96, TLI = 0.94, and χ(2) = 176.06, df = 75, p < .001) demonstrated a significant indirect effect of sensation seeking on phone sexting behaviors through sex-related sexting expectancies and a significant indirect effect of sensation seeking on sexual hookup behaviors through phone sexting behaviors (b = 0.06, p = .03), but only for females. Reverse mediations and mediation with SNS were not significant. Negative outcomes were rare: sexts being spread to others was the most common negative sexting experience (n = 21, 12 %). This study suggests the viability of personality and expectancies affecting sexual hookup behaviors through engagement in sexting behaviors. It also suggests that although direct negative outcomes associated with sexting are thought to be common, they were rare in the current sample.
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Affiliation(s)
- Allyson L Dir
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford St., Indianapolis, IN, 46202, USA,
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104
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STI/HIV Sexual Risk Behavior and Prevalent STI Among Incarcerated African American Men in Committed Partnerships: The Significance of Poverty, Mood Disorders, and Substance Use. AIDS Behav 2015; 19:1478-90. [PMID: 25863467 DOI: 10.1007/s10461-015-1062-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
African Americans face disproportionate sexually transmitted infection including HIV (STI/HIV), with those passing through a correctional facility at heightened risk. There is a need to identify modifiable STI/HIV risk factors among incarcerated African Americans. Project DISRUPT is a cohort study of incarcerated African American men recruited from September 2011 through January 2014 from prisons in North Carolina who were in committed partnerships with women at prison entry (N = 207). During the baseline (in-prison) study visit, participants responded to a risk behavior survey and provided a urine specimen, which was tested for STIs. Substantial proportions reported multiple partnerships (42 %), concurrent partnerships (33 %), and buying sex (11 %) in the 6 months before incarceration, and 9 % tested positive for an STI at baseline (chlamydia: 5.3 %, gonorrhea: 0.5 %, trichomoniasis: 4.9 %). Poverty and depression appeared to be strongly associated with sexual risk behaviors. Substance use was linked to prevalent STI, with binge drinking the strongest independent risk factor (adjusted odds ratio: 3.79, 95 % CI 1.19-12.04). There is a continued need for improved prison-based STI testing, treatment, and prevention education as well as mental health and substance use diagnosis.
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105
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Cepeda A, Nowotny KM, Valdez A. Injecting Drug Use Among Mexican Female Sex Workers on the US-Mexico Border. J Ethn Subst Abuse 2015. [PMID: 26211392 DOI: 10.1080/15332640.2014.991467] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Both injecting drug users (IDU) and sex workers are at great risk of contracting and transmitting HIV. Therefore, IDU sex workers could be at especially high risk. The recent increase of HIV infection in Mexico has caused increased attention to sex work. We identify the correlates of injecting drug use including socio-demographic, work history, and sexual and non-injecting drug use risk behaviors among Mexican female sex workers. There is a high risk profile for IDUs compared to never injectors including a high prevalence of lifetime STI infection (54.2%). Revealed is an environment composed of high-risk networks that may have serious binational public health implications.
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Affiliation(s)
- Alice Cepeda
- a University of Southern California , Los Angeles , California
| | | | - Avelardo Valdez
- a University of Southern California , Los Angeles , California
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106
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Uyei J, Li L, Braithwaite RS. HIV and Alcohol Research Priorities of City, State, and Federal Policymakers: Results of a Delphi Study. Am J Public Health 2015; 105:e23-6. [PMID: 26180968 DOI: 10.2105/ajph.2015.302799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We identified the research areas related to HIV and alcohol consumption that were of highest priority to city, state, and federal policymakers. From June to July 2014, we conducted a 3-round Delphi study to elicit from experts a list of alcohol- and HIV-related clinical trial research questions that were important to fund and rank order the list to identify questions of highest priority. Translating evidence into practice must be improved because some questions that have been extensively studied with results published in peer-reviewed journals were identified by the panel as areas needing additional research.
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Affiliation(s)
- Jennifer Uyei
- All of the authors are with the Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University School of Medicine, New York, NY
| | - Lingfeng Li
- All of the authors are with the Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University School of Medicine, New York, NY
| | - Ronald Scott Braithwaite
- All of the authors are with the Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University School of Medicine, New York, NY
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107
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Lelutiu-Weinberger C, Pachankis JE, Gamarel KE, Surace A, Golub SA, Parsons JT. Feasibility, Acceptability, and Preliminary Efficacy of a Live-Chat Social Media Intervention to Reduce HIV Risk Among Young Men Who Have Sex With Men. AIDS Behav 2015; 19:1214-27. [PMID: 25256808 PMCID: PMC4375068 DOI: 10.1007/s10461-014-0911-z] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Given the popularity of social media among young men who have sex with men (YMSM), and in light of YMSM's elevated and increasing HIV rates, we tested the feasibility, acceptability and preliminary efficacy of a live chat intervention delivered on Facebook in reducing condomless anal sex and substance use within a group of high risk YMSM in a pre-post design with no control group. Participants (N = 41; 18-29 years old) completed up to eight one-hour motivational interviewing and cognitive behavioral skills-based online live chat intervention sessions, and reported on demographic, psychosocial, and behavioral characteristics at baseline and immediately post-intervention. Analyses indicated that participation in the intervention (n = 31) was associated with reductions of days of drug and alcohol use in the past month and instances of anal sex without a condom (including under the influence of substances), as well as increases in knowledge of HIV-related risks at 3-month follow-up. This pilot study argues for the potential of this social media-delivered intervention to reduce HIV risk among a most vulnerable group in the United States, in a manner that was highly acceptable to receive and feasible to execute. A future randomized controlled trial could generate an intervention blueprint for providers to support YMSM's wellbeing by reaching them regardless of their geographical location, at a low cost.
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Affiliation(s)
- Corina Lelutiu-Weinberger
- Department of Psychology, Hunter AIDS Research Team (HART), Hunter College, City University of New York (CUNY), 695 Park Avenue, HN Room 1209, New York, NY 10065, USA, URL: http://cunyhart.org/
| | - John E. Pachankis
- Chronic Disease Epidemiology, Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA
| | - Kristi E. Gamarel
- Department of Psychology, Hunter AIDS Research Team (HART), Hunter College, City University of New York (CUNY), 695 Park Avenue, HN Room 1209, New York, NY 10065, USA
- Alpert Medical School of Brown University, 167 Point Street, Providence, RI 023093, USA
| | - Anthony Surace
- Department of Psychology, Hunter AIDS Research Team (HART), Hunter College, City University of New York (CUNY), 695 Park Avenue, HN Room 1209, New York, NY 10065, USA
| | - Sarit A. Golub
- Department of Psychology, Hunter AIDS Research Team (HART), Hunter College, City University of New York (CUNY), 695 Park Avenue, HN Room 1209, New York, NY 10065, USA
- Health Psychology and Basic and Applied Social Psychology Doctoral Programs, the Graduate Center, CUNY, 365 Fifth Avenue, New York, NY 10016, USA
| | - Jeffrey T. Parsons
- Department of Psychology, Hunter AIDS Research Team (HART), Hunter College, City University of New York (CUNY), 695 Park Avenue, HN Room 1209, New York, NY 10065, USA
- Health Psychology and Basic and Applied Social Psychology Doctoral Programs, the Graduate Center, CUNY, 365 Fifth Avenue, New York, NY 10016, USA
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 West 36th Street, 9th Floor, New York, NY 10018, USA
- CUNY School of Public Health at Hunter College, 2180 Third Avenue, New York, NY 10035, USA
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108
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Wray TB, Celio MA, Kahler CW, Barnett NP, Mastroleo NR, Operario D, Monti PM. Daily co-occurrence of alcohol use and high-risk sexual behavior among heterosexual, heavy drinking emergency department patients. Drug Alcohol Depend 2015; 152:109-15. [PMID: 25962789 PMCID: PMC4458208 DOI: 10.1016/j.drugalcdep.2015.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/01/2015] [Accepted: 04/16/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Global association and experimental studies suggest that alcohol use may increase sexual behavior that poses risk for exposure to sexually transmitted infections (STI) among heterosexual men and women. However, results from longitudinal and daily recall studies exploring the co-occurrence of alcohol use with various sexual risk outcomes in more naturalistic contexts have been mixed, and the bulk of this research has focused on college students. METHODS The current study enrolled heavy-drinking emergency department (ED) patients and used a cross-sectional, 30-day Timeline Followback (TLFB) method to examine the daily co-occurrence between alcohol use and three sexual behavior outcomes: Any sex, unprotected intercourse (UI), and UI with casual partners (versus protected intercourse [PI] with casual partners, or UI/PI with steady partners). RESULTS Results indicated that increasing levels of alcohol use on a given day increased the odds of engaging in any sexual activity and that heavy drinking (but not very heavy drinking) on a given day was associated with an increased odds of engaging in UI with either steady or casual partners. However, day-level alcohol use was not associated with an increased odds of UI with casual partners. CONCLUSIONS These findings suggest that alcohol may play an important role in increasing risk for HIV/STIs among heterosexuals, and support the continued need to target heavy drinking in sex risk reduction interventions. However, our results also suggest that alcohol may not universally result in unprotected sex with casual partners, a behavior posing perhaps the highest risk for HIV/STI transmission.
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Affiliation(s)
- Tyler B Wray
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, RI, United States.
| | - Mark A Celio
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, RI, United States
| | - Christopher W Kahler
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, RI, United States
| | - Nancy P Barnett
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, RI, United States
| | - Nadine R Mastroleo
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, RI, United States
| | - Don Operario
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, RI, United States
| | - Peter M Monti
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, RI, United States
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109
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Salas-Wright CP, Vaughn MG, Ugalde J, Todic J. Substance use and teen pregnancy in the United States: evidence from the NSDUH 2002-2012. Addict Behav 2015; 45:218-25. [PMID: 25706068 DOI: 10.1016/j.addbeh.2015.01.039] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/05/2015] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Few, if any, studies have systematically examined the relationship between substance use and teen pregnancy using population-based samples. We aim to provide a comprehensive examination of substance use among pregnant adolescents in the United States. METHOD Employing data from the National Survey on Drug Use and Health between 2002 and 2012 (n=97,850), we examine the prevalence of the past 12-month and the past 30-day substance use and substance use disorders among pregnant and non-pregnant adolescents (ages 12-17). We also examine psychosocial and pregnancy-related correlates of current substance use among the subsample of pregnant adolescents (n=810). RESULTS Pregnant teens were significantly more likely to have experimented with a variety of substances and meet criteria for alcohol (AOR=1.65, 95% CI=1.26-2.17), cannabis (AOR=2.29, 95% CI=1.72-3.04), and other illicit drug use disorders (AOR=2.84, 95% CI=1.92-4.19). Pregnant early adolescents (ages 12-14; AOR=4.34, 95% CI=2.28-8.26) were significantly more likely and pregnant late adolescents (ages 15-17; AOR=0.71, 95% CI=0.56-0.90) significantly less likely than their non-pregnant counterparts to be current substance users. CONCLUSIONS Study findings point not only to a relationship between pregnancy and prior substance use, but also suggest that substance use continues for many teens during pregnancy. We found that substance use is particularly problematic among early adolescents and that the prevalence of substance use attenuates dramatically as youth progress from the first to the second and third trimesters of pregnancy.
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110
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Alcohol use among Latino migrant workers in South Florida. Drug Alcohol Depend 2015; 151:241-9. [PMID: 25891232 DOI: 10.1016/j.drugalcdep.2015.03.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 03/23/2015] [Accepted: 03/26/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND A significant segment of the Latino migrant worker population in the United States is at high risk for alcohol abuse and related risk behaviors. Information about the prevalence of alcohol use and abuse and its association with sociodemographic and psychological variables is needed for designing effective intervention prevention strategies. METHODS Cross-sectional data were drawn from a baseline assessment that was part of a randomized controlled trial of 278 Latino migrant workers (LMWs) conducted between 2008 and 2010. RESULTS About one-third (32%) of participants engaged in heavy drinking in the past 30 days prior to baseline interview. More females than males reported no alcohol use in the past 30 days (53.5% vs. 20.5%). On the other hand, more males reported drinking every day or nearly (25.2% vs. 7.1%). Five factors-gender, country of origin, relationship status, living arrangements, and acculturation-were significantly associated with frequency of alcohol consumption. Multivariate analyses indicated that gender, country of origin, education attainment, relationship status, living arrangement, living with children, length of stay in the US, religious beliefs, acculturation, and depression were associated with frequent heavy drinking, alcohol abuse/dependence, and unprotected sex under the influence of alcohol. CONCLUSIONS There is significant variation in alcohol use among Latino migrant workers. Although a substantial proportion of this population abstains from alcohol, an equally substantial proportion report levels of alcohol use that pose significant risk. More research is needed to better understand drinking patterns in this community in order to design prevention strategies specifically tailored for this population.
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111
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Wechsberg WM, Deren S, Myers B, Kirtadze I, Zule WA, Howard B, El-Bassel N. Gender-Specific HIV Prevention Interventions for Women Who Use Alcohol and Other Drugs: The Evolution of the Science and Future Directions. J Acquir Immune Defic Syndr 2015; 69 Suppl 2:S128-39. [PMID: 25978479 PMCID: PMC4505613 DOI: 10.1097/qai.0000000000000627] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The use of alcohol and other drugs (AODs) is an important driver of gender disparities in HIV prevalence. Consequently, there is a need for women-specific HIV interventions that are conceptualized to address (1) women's risk behavior, their roles in sexual relationships, and gender power dynamics and (2) other issues commonly faced by women who use AODs, such as gender-based violence and victimization. This article presents the evolution of HIV prevention intervention research with women who use AODs. It looks at 3 generations of women-focused HIV research interventions, including first-generation projects that started in the 1990s, second-generation efforts where projects expanded in scope and included adaptions of evidence-based interventions for global relevance, and finally third-generation projects currently underway that combine biobehavioral methods and are being implemented in real-world settings. Because women who use AODs continue to report risk behaviors related to HIV, emphasis should be placed on training scientists to conduct gender-specific studies, increasing funding for new studies, and advocating to ensure that stigma-free services are available for these at-risk women.
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Affiliation(s)
- Wendee M. Wechsberg
- RTI International, Research Triangle Park, NC, USA
- University of North Carolina, Chapel Hill, NC, USA
- Department of Psychology in the Public Interest, North Carolina State University, Raleigh, NC, USA
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Sherry Deren
- Center for Drug Use and HIV Research, College of Nursing, New York University, New York, NY, USA
| | - Bronwyn Myers
- Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Irma Kirtadze
- Addiction Research Center, Alternative Georgia, Tbilisi, Georgia
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112
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Rosenberg M, Pettifor A, Van Rie A, Thirumurthy H, Emch M, Miller WC, Gómez-Olivé FX, Twine R, Hughes JP, Laeyendecker O, Selin A, Kahn K. The Relationship between Alcohol Outlets, HIV Risk Behavior, and HSV-2 Infection among South African Young Women: A Cross-Sectional Study. PLoS One 2015; 10:e0125510. [PMID: 25954812 PMCID: PMC4425652 DOI: 10.1371/journal.pone.0125510] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 02/17/2015] [Indexed: 11/17/2022] Open
Abstract
Background Alcohol consumption has a disinhibiting effect that may make sexual risk behaviors and disease transmission more likely. The characteristics of alcohol-serving outlets (e.g. music, dim lights, lack of condoms) may further encourage risky sexual activity. We hypothesize that frequenting alcohol outlets will be associated with HIV risk. Methods In a sample of 2,533 school-attending young women in rural South Africa, we performed a cross-sectional analysis to examine the association between frequency of alcohol outlet visits in the last six months and four outcomes related to HIV risk: number of sex partners in the last three months, unprotected sex acts in the last three months, transactional sex with most recent partner, and HSV-2 infection. We also tested for interaction by alcohol consumption. Results Visiting alcohol outlets was associated with having more sex partners [adjusted odds ratio (aOR), one versus zero partners (95% confidence interval (CI)): 1.51 (1.21, 1.88)], more unprotected sex acts [aOR, one versus zero acts (95% CI): 2.28 (1.52, 3.42)], higher levels of transactional sex [aOR (95% CI): 1.63 (1.03, 2.59)], and HSV-2 infection [aOR (95% CI): 1.30 (0.88, 1.91)]. In combination with exposure to alcohol consumption, visits to alcohol outlets were more strongly associated with all four outcomes than with either risk factor alone. Statistical evidence of interaction between alcohol outlet visits and alcohol consumption was observed for all outcomes except transactional sex. Conclusions Frequenting alcohol outlets was associated with increased sexual risk in rural South African young women, especially when they consumed alcohol. Sexual health interventions targeted at alcohol outlets may effectively reach adolescents at high risk for sexually transmitted infections like HIV and HSV-2. Trial Registration HIV Prevention Trials Network HPTN 068
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Affiliation(s)
- Molly Rosenberg
- Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, United States of America; Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Audrey Pettifor
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Annelies Van Rie
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Harsha Thirumurthy
- Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; Department of Health Policy and Management, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Michael Emch
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; Department of Geography, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - William C Miller
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
| | - Oliver Laeyendecker
- Laboratory of Immunoregulation, NIAID, NIH, Baltimore, Maryland, United States of America; Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Amanda Selin
- Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Centre for Global Health Research, Umeå University, Umeå, Sweden; INDEPTH Network, Accra, Ghana
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Rosenberg M, Pettifor A, Lippman SA, Thirumurthy H, Emch M, Miller WC, Selin A, Gómez-Olivé FX, Hughes JP, Laeyendecker O, Tollman S, Kahn K. Relationship between community-level alcohol outlet accessibility and individual-level herpes simplex virus type 2 infection among young women in South Africa. Sex Transm Dis 2015; 42:259-65. [PMID: 25868138 PMCID: PMC4436694 DOI: 10.1097/olq.0000000000000263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Exposure to alcohol outlets may influence sexual health outcomes at the individual and community levels. Visiting alcohol outlets facilitates alcohol consumption and exposes patrons to a risky environment and network of potential partners, whereas the presence of alcohol outlets in the community may shift social acceptance of riskier behavior. We hypothesize that living in communities with more alcohol outlets is associated with increased sexual risk. METHODS We performed a cross-sectional analysis in a sample of 2174 South African schoolgirls (ages 13-21 years) living across 24 villages in the rural Agincourt subdistrict, underpinned by long-term health and sociodemographic surveillance. To examine the association between number of alcohol outlets in village of residence and individual-level prevalent herpes simplex virus type 2 (HSV-2) infection, we used generalized estimating equations with logit links, adjusting for individual- and village-level covariates. RESULTS The median number of alcohol outlets per village was 3 (range, 0-7). Herpes simplex virus type 2 prevalence increased from villages with no outlets (1.4% [95% confidence interval, 0.2-12.1]), to villages with 1 to 4 outlets (4.5% [3.7-5.5]), and to villages with more than 4 outlets (6.3% [5.6, 7.1]). An increase of 1 alcohol outlet per village was associated with an 11% increase in the odds of HSV-2 infection (adjusted odds ratio [95% confidence interval], 1.11 [0.98-1.25]). CONCLUSIONS Living in villages with more alcohol outlets was associated with increased prevalence of HSV-2 infection in young women. Structural interventions and sexual health screenings targeting villages with extensive alcohol outlet environments could help prevent the spread of sexually transmitted infections.
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Affiliation(s)
- Molly Rosenberg
- Center for Population and Development Studies, Harvard School of Public Health, Cambridge, MA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill
- Carolina Population Center, University of North Carolina-Chapel Hill
| | - Audrey Pettifor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill
- Carolina Population Center, University of North Carolina-Chapel Hill
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Sheri A. Lippman
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Harsha Thirumurthy
- Carolina Population Center, University of North Carolina-Chapel Hill
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina-Chapel Hill
| | - Michael Emch
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill
- Carolina Population Center, University of North Carolina-Chapel Hill
- Department of Geography, University of North Carolina-Chapel Hill
| | - William C. Miller
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina-Chapel Hill
| | - Amanda Selin
- Carolina Population Center, University of North Carolina-Chapel Hill
| | - F. Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
- INDEPTH Network, Accra, Ghana
| | - James P. Hughes
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Oliver Laeyendecker
- Laboratory of Immunoregulation, NIAID, NIH, Baltimore MD
- Department of Medicine, Johns Hopkins University, Baltimore MD
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
- INDEPTH Network, Accra, Ghana
- Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
- INDEPTH Network, Accra, Ghana
- Centre for Global Health Research, Umeå University, Umeå, Sweden
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Traumatic stress and the mediating role of alcohol use on HIV-related sexual risk behavior: results from a longitudinal cohort of South African women who attend alcohol-serving venues. J Acquir Immune Defic Syndr 2015; 68:322-8. [PMID: 25394191 DOI: 10.1097/qai.0000000000000433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND In South Africa, alcohol contributes to the HIV epidemic, in part, by influencing sexual behaviors. For some, high levels of alcohol consumption may be driven by previous traumatic experiences that result in traumatic stress. The purpose of this study was to quantify the longitudinal association between traumatic stress and unprotected sex among women who attend drinking venues and to assess whether this association was explained by mediation through alcohol use. METHODS Data were collected in 4 waves over a year from a prospective cohort of 560 women who regularly attended alcohol-serving venues in a Cape Town township. Longitudinal mixed models examined (1) the relationship between traumatic stress and counts of unprotected sex and (2) whether alcohol use mediated the association between traumatic stress and unprotected sex. RESULTS Most women reported elevated traumatic stress (80%) and hazardous alcohol use (88%) at least once during the study period. In models adjusted for covariates, traumatic stress was associated with unprotected sex (b = 0.28, SE = 0.06, t = 4.82, P < 0.001). In addition, traumatic stress was associated with alcohol use (b = 0.27, SE = 0.02, t = 14.25, P < 0.001) and was also associated with unprotected sex (b = 0.20, SE = 0.06, t = 3.27, P < 0.01) while controlling for alcohol use (b = 0.28, SE = 0.07, t = 4.25, P < 0.001). The test for the mediated effect established that alcohol use was a significant mediator, accounting for 27% of the total effect of traumatic stress on unprotected sex. CONCLUSIONS These results highlight the need to address traumatic stress among female venue patrons as an important precursor of HIV risk due to alcohol use.
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Tat SA, Marrazzo JM, Graham SM. Women Who Have Sex with Women Living in Low- and Middle-Income Countries: A Systematic Review of Sexual Health and Risk Behaviors. LGBT Health 2015; 2:91-104. [PMID: 26790114 DOI: 10.1089/lgbt.2014.0124] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Women who have sex with women (WSW) have long been considered at low risk of acquiring and transmitting HIV and other sexually transmitted infections (STIs). However, limited research has been conducted on WSW, especially those living in low-and middle-income countries (LMICs). We reviewed available research on sexual health and risk behaviors of WSW in LMICs. We searched CINAHL, Embase, and PubMed for studies of WSW in LMICs published between January 1, 1980, and December 31, 2013. Studies of any design and subject area that had at least two WSW participants were included. Data extraction was performed to report quantifiable WSW-specific results related to sexual health and risk behaviors, and key findings of all other studies on WSW in LMICs. Of 652 identified studies, 56 studies from 22 countries met inclusion criteria. Reported HIV prevalence among WSW ranged from 0% in East Asia and Pacific and 0%-2.9% in Latin America and the Caribbean to 7.7%-9.6% in Sub-Saharan Africa. Other regions did not report WSW HIV prevalence. Overall, many WSW reported risky sexual behaviors, including sex with men, men who have sex with men (MSM), and HIV-infected partners; transactional sex; and substance abuse. WSW are at risk for contracting HIV and STIs. While the number of research studies on WSW in LMICs continues to increase, data to address WSW sexual health needs remain limited.
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Affiliation(s)
- Susana A Tat
- 1 Department of Medicine, University of Washington , Seattle, Washington
| | - Jeanne M Marrazzo
- 1 Department of Medicine, University of Washington , Seattle, Washington
| | - Susan M Graham
- 1 Department of Medicine, University of Washington , Seattle, Washington.,2 Department of Epidemiology, University of Washington , Seattle, Washington.,3 Department of Global Health, University of Washington , Seattle, Washington
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Hammarström S, Tikkanen R, Stenqvist K. Identification and risk assessment of Swedish youth at risk of chlamydia. Scand J Public Health 2015; 43:399-407. [PMID: 25740618 DOI: 10.1177/1403494815572722] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2015] [Indexed: 11/17/2022]
Abstract
AIMS The aim of the study was to identify youth at high risk of chlamydia including variables related to sexual health and negative experiences of sexuality. METHODS In late 2009, a questionnaire on sexuality was answered by Swedish youth. The study sample was self-selected from different Internet communities. Data from 6544 sexually active participants, aged 15-24 years, were analyzed in a multivariable logistic regression model. Discriminative power was measured by the area under the receiver operating characteristic curve. RESULTS In the univariate analysis, self-reported chlamydia was associated with most risk behavior variables, experience of coerced sex, and reimbursement for sex, with slight gender variation. The factors that best predicted self-reported chlamydia among females were number of partners, age, and having been reimbursed for sex. Among males, the number of partners and alcohol consumption were the strongest predictors. Increasing number of partners up to 10 during the past 12 months was the most important predictor for both genders. A skewed distribution of chlamydia was demonstrated, in that 37.6% of cases in females and 38.6% in males were estimated to occur among a tenth of the population. CONCLUSIONS Testing, prevention, and care for chlamydia should be directed toward those most at risk, as they account for a large proportion of the total number of chlamydia cases. The special needs of the high-risk group need to be acknowledged and chlamydia regarded as a possible marker for risk behavior and negative sexuality experiences.
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Affiliation(s)
| | - Ronny Tikkanen
- Department of Social Work, University of Gothenburg, Sweden
| | - Karin Stenqvist
- Section of Social Medicine, University of Gothenburg and Knowledge Center for Sexual Health, Region Västra Götaland, Sweden
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Hess KL, Chavez PR, Kanny D, DiNenno E, Lansky A, Paz-Bailey G. Binge drinking and risky sexual behavior among HIV-negative and unknown HIV status men who have sex with men, 20 US cities. Drug Alcohol Depend 2015; 147:46-52. [PMID: 25555622 PMCID: PMC4579526 DOI: 10.1016/j.drugalcdep.2014.12.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/11/2014] [Accepted: 12/12/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) represent over half of new HIV infections in the United States. It is important to understand the factors associated with engaging in risky sexual behavior to develop effective prevention interventions. Binge drinking (≥5 drinks on ≥1 occasion) is the most common form of excessive alcohol consumption. This study examines the relationship between binge drinking and sexual risk behaviors among MSM who are current drinkers and who were either HIV-negative or unaware of their HIV status. METHODS Using the 2011 National HIV Behavioral Surveillance system and multivariable Poisson models with robust error estimates, we assessed the association between binge drinking and sexual risk behaviors among current drinkers. Prevalence ratios (PR) and 95% confidence intervals (CI) are presented. RESULTS Overall, 85% of MSM were current drinkers, and 59% of MSM who drank reported ≥1 episode of binge drinking in the preceding 30 days. In multivariable models, binge drinking was associated with condomless anal intercourse (CAI) at last sex with an HIV-positive or unknown status partner (receptive: PR 1.3, 95% CI 1.1-1.6; insertive: PR 1.2, 95% CI 1.0-1.4), having exchanged sex for money or drugs at last sex (PR: 1.4, 95% CI 1.1-1.7), having concurrent partners in the past year (PR: 1.1, 95% CI 1.1-1.2), and having more CAI partners in the past year (PR: 1.2, 95% CI 1.0-1.4) compared to non-binge drinkers. CONCLUSIONS Evidence-based strategies for reducing binge drinking could help reduce risky sexual behavior among MSM.
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Affiliation(s)
- Kristen L Hess
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS-E46, Atlanta, GA 30329, USA.
| | - Pollyanna R Chavez
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS-E46, Atlanta, GA 30329, USA.
| | - Dafna Kanny
- Excessive Alcohol Use Prevention Team, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS-F78, Atlanta, GA 30329, USA.
| | - Elizabeth DiNenno
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS-E46, Atlanta, GA 30329, USA.
| | - Amy Lansky
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS-D21, Atlanta, GA 30329, USA.
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS-E46, Atlanta, GA 30329, USA.
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Lawi JDT, Mirambo MM, Magoma M, Mushi MF, Jaka HM, Gumodoka B, Mshana SE. Sero-conversion rate of Syphilis and HIV among pregnant women attending antenatal clinic in Tanzania: a need for re-screening at delivery. BMC Pregnancy Childbirth 2015; 15:3. [PMID: 25613487 PMCID: PMC4307991 DOI: 10.1186/s12884-015-0434-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 01/12/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Despite the available cost effective antenatal testing and treatment, syphilis and human immunodeficiency virus (HIV) are still among common infections affecting pregnant women especially in developing countries. In Tanzania, pregnant women are tested only once for syphilis and HIV during antenatal clinic (ANC) visits. Therefore, there are missed opportunities for syphilis and HIV screening among those who were not tested during ANC visits and those acquiring infections during the course of pregnancy. This study was designed to determine the syphilis and HIV seroprevalence at delivery and seroconversion rate among pregnant women delivering at Bugando Medical Centre (BMC). METHODS A cross sectional, hospital-based study involving pregnant women attending Bugando Medical Centre (BMC) antenatal clinic was done from January to March 2012. Serum samples were collected and tested for HIV and syphilis using HIV and syphilis rapid tests. Demographic and clinical data were collected using a standardized data collection tool and analysed using STATA version 11. RESULTS A total of 331 and 408 women were screened for syphilis and HIV during antenatal respectively. Of 331 women who screened negative for syphilis at ANC, nine (2.7%) were seropositive at delivery while of 391who tested negative for HIV during ANC eight (2%) were found to be positive at delivery. Six (1.8%) and 23 (9%) of women who did not screen for syphilis and HIV at ANC were seropositive for syphilis and HIV at delivery respectively. There was significant difference of seroprevalence for HIV, among women who tested negative at ANC and those who did not test at ANC (2% vs.9%, P,<0.001). The overall prevalence of syphilis and HIV at delivery was 15 (2.3%) and 48 (7.2%) respectively. Syphilis seropositivity at delivery was significantly associated with HIV co-infection (p < 0.001), male partner circumcision (p = 0.011) and alcohol use among women (p < 0.001). CONCLUSIONS The current protocol of screening for syphilis and HIV only once during pregnancy as practiced in Tanzania may miss women who get re-infected and seroconvert during pregnancy. Re-screening for syphilis and HIV during the course of pregnancy and at delivery is recommended in Tanzania as it can help to identify such women and institute appropriate treatment.
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Affiliation(s)
- John D T Lawi
- Ministry of health and social welfare, Department of Curative services, P.O. Box 9083, Dar esSalaam, Tanzania.
| | - Mariam M Mirambo
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania.
| | - Moke Magoma
- Evidence for Action Project, P.O. Box 13731, Dar es salaam, Tanzania.
| | - Martha F Mushi
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania.
| | - Hyasinta M Jaka
- Department of Internal medicine, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania.
| | - Balthazary Gumodoka
- Department of Obstetrics & Gynecology Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania.
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania.
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Nyamhanga TM, Frumence G. Gender context of sexual violence and HIV sexual risk behaviors among married women in Iringa Region, Tanzania. Glob Health Action 2014; 7:25346. [PMID: 25491040 PMCID: PMC4260407 DOI: 10.3402/gha.v7.25346] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 11/04/2014] [Accepted: 11/07/2014] [Indexed: 11/16/2022] Open
Abstract
Background There is a dearth of empirical research illuminating possible connections between gender imbalances and sexual violence among married women in Tanzania. There is a need to generate in-depth information on the connectivity between gender imbalances (asymmetrical resource ownership, sexual decision making, roles, and norms) and sexual violence plus associated HIV risky sexual behavior among married women. Design This paper is based on a qualitative case study that involved use of focus group discussions (FGDs). A thematic analysis approach was used in analyzing the study findings. Results The study findings are presented under the three structures of gender and power theory. On sexual division of labor, our study found that economic powerlessness exposes women to sexual violence.
On sexual division of power, our study found that perception of the man as a more powerful partner in marriage is enhanced by the biased marriage arrangement and alcohol consumption. On cathexis, this study has revealed that because of societal norms and expectations regarding women's sexual behavior characterized by their sexual and emotional attachments to men, women find it hard to leave sexually abusive marriages. That is, because of societal expectations of obedience and compelled tolerance many married women do suffer in silence. They find themselves trapped in marriages that increase their risk of acquiring HIV. Conclusions This study suggests that married women experience a sexual risk of acquiring HIV that results from non-consensual sex. That non-consensual sex is a function of gender imbalances – ranging from women's economic dependence on their husbands or partners to socioculturally rooted norms and expectations regarding women's sexual behavior. The HIV risk is especially heightened because masculine sexual norms encourage men [husbands/partners] to engage in unprotected intra- and extramarital sex. It is recommended that the Tanzania Commission for AIDS (TACAIDS) should address the gender dimensions of sexual violence in marriage.
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Affiliation(s)
- Tumaini M Nyamhanga
- Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;
| | - Gasto Frumence
- Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Elkington KS, Bauermeister JA, Santamaria EK, Dolezal C, Mellins CA. Substance use and the development of sexual risk behaviors in youth perinatally exposed to HIV. J Pediatr Psychol 2014; 40:442-54. [PMID: 25476800 DOI: 10.1093/jpepsy/jsu103] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 11/03/2014] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To examine the longitudinal association between sexual behavior and substance use in perinatally HIV-infected (PHIV+) and perinatally HIV-exposed-but-uninfected (PHIV-) youth. METHODS Growth curve modeling was used with data from N = 340 PHIV-exposed youth (60.6% PHIV+; 9-22 years) to estimate the onset of penetrative and unprotected sex across time, adding alcohol and marijuana use trajectories as time-varying covariates and examining HIV-status differences. RESULTS The odds of penetrative or unprotected sex more than doubled across time. Alcohol and marijuana use significantly increased the odds of engaging in sex and unprotected sex, with no HIV-status differences. The association between unprotected sex and alcohol use was less salient for PHIV+ than PHIV- youth. CONCLUSIONS Similar to youth from other populations, PHIV+ and PHIV- youth are increasingly engaging in sex and substance use as they age. Targeted interventions to prevent sexual risk behavior and further HIV transmission should address the influence of substance use.
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Affiliation(s)
- Katherine S Elkington
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University and Center for Sexuality & Health Disparities, School of Public Health, University of Michigan
| | - José A Bauermeister
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University and Center for Sexuality & Health Disparities, School of Public Health, University of Michigan
| | - E Karina Santamaria
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University and Center for Sexuality & Health Disparities, School of Public Health, University of Michigan
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University and Center for Sexuality & Health Disparities, School of Public Health, University of Michigan
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University and Center for Sexuality & Health Disparities, School of Public Health, University of Michigan
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Correlates of incident Trichomonas vaginalis infections among African American female adolescents. Sex Transm Dis 2014; 41:240-5. [PMID: 24622635 DOI: 10.1097/olq.0000000000000094] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trichomonas vaginalis is the most common curable sexually transmitted infection associated with adverse reproductive health and pregnancy outcomes and may amplify HIV transmission. The objective was to identify correlates of incident T. vaginalis infections among African American adolescent girls. METHODS Data were collected via audio computer-assisted self-interviews at baseline and every 6 months for 18 months from 701 African American girls (14-20 years) in an HIV prevention trial. At each assessment, self-collected vaginal swabs were assayed for T. vaginalis, Chlamydia trachomatis, and Neisseria gonorrhoeae. Generalized estimating equations assessed associations between incident T. vaginalis infection and sociodemographic characteristics, substance use, partner-level factors, sexual risk behaviors, douching, and other sexually transmitted infections. RESULTS Of 605 (86.3%) participants who completed at least 1 follow-up assessment, an incident T. vaginalis infection was detected among 20.0% (n = 121). Factors associated with incident infection in adjusted analysis included the following: cigarette smoking (adjusted odds ratio [AOR], 1.66; 95% confidence interval [CI], 1.04-2.64), using alcohol on an increasing number of days in the past 3 months (AOR, 1.02; 95% CI, 1.00-1.04), acquisition of C. trachomatis (AOR, 2.27; 95% CI, 1.40-3.69) or N. gonorrhoeae (AOR, 5.71; 95% CI, 2.97-11.02), and T. vaginalis infection at the previous assessment (AOR, 3.16; 95% CI, 1.96-5.07). CONCLUSIONS Incident T. vaginalis infections were common. Strategies to reduce infection rates among this population may include improving partner notification and treatment services. The benefits of rescreening, screening adolescents screened for or infected with C. trachomatis or N. gonorrhoeae, and associations between substance use and T. vaginalis acquisition warrant further investigation.
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Parcesepe AM, Toivgoo A, Chang M, Riedel M, Carlson C, DiBennardo R, Witte SS. Physical and sexual violence, childhood sexual abuse and HIV/STI risk behaviour among alcohol-using women engaged in sex work in Mongolia. Glob Public Health 2014; 10:88-102. [PMID: 25383593 DOI: 10.1080/17441692.2014.976240] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Although the prevalence of human immunodeficiency virus (HIV) in Mongolia is low, it could increase without strategic prevention strategies. Female sex workers (FSWs) often experience barriers to prevention, including interpersonal violence. This study investigated if childhood sexual abuse (CSA) or recent physical or sexual violence was associated with HIV sexual risk behaviours and if CSA modified associations between recent violence and HIV sexual risk behaviours. Two-hundred twenty-two women who (1) were at least 18 years old and clients at the National AIDS Foundation; (2) reported vaginal or anal sex in the past 90 days in exchange for money or goods and (3) met criteria for harmful alcohol use in the past year were enrolled. In-person interviews assessed sexual risk behaviours and violence in childhood and adulthood. Negative binomial regression, ordinary least squares regression and modified Poisson regression were performed. Sexual risk with paying partners was associated with penetrative CSA and sexual violence by paying partners. CSA and recent violence were not associated with sexual risk behaviours with intimate partners. CSA modified the association between recent sexual violence and unprotected sex with intimate partners. Findings highlight the need for integrated violence and sexual risk reduction services to ensure safe and effective prevention for FSWs.
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Affiliation(s)
- Angela M Parcesepe
- a Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
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Radcliffe K, Thorley N. Screening for alcohol misuse in sexual health clinics. Sex Transm Infect 2014; 91:4-5. [DOI: 10.1136/sextrans-2014-051881] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Fantasia HC, Sutherland MA, Fontenot H, Ierardi JA. Knowledge, attitudes and beliefs about contraceptive and sexual consent negotiation among college women. JOURNAL OF FORENSIC NURSING 2014; 10:199-207. [PMID: 25411811 DOI: 10.1097/jfn.0000000000000046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
College women have the highest rates of sexual violence, sexually transmitted infections, and unintended pregnancy compared with women in all other age groups. Although much is known about sexual risk behaviors among college women, less is known about how women negotiate consent for contraceptive use during sexual encounters. Therefore, the purpose of this qualitative descriptive study was to explore college women's knowledge, attitudes, and beliefs about contraceptive and sexual consent during dating relationships. Twenty-six women participated in five focus groups on two college campuses in the northeastern United States. Content analysis was used to analyze the data. The three main categories that emerged from the analysis included the influence of alcohol on sexual behaviors, lack of negotiation for sexual consent and contraceptive use, and fear of pregnancy. The results of this study highlight the complex social interactions and norms that college women encounter when making decisions regarding sexual activity and contraceptive use. The results of this study can inform the role of college health providers and forensic nurses to promote sexual health and safety when they interact with college women.
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Affiliation(s)
- Heidi Collins Fantasia
- Author Affiliations: 1College of Health Sciences, School of Nursing, University of Massachusetts Lowell; 2William F. Connell School of Nursing, Boston College; and 3Lawrence Memorial/Regis College, University of Massachusetts Lowell
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Ashton LM, Hutchesson MJ, Rollo ME, Morgan PJ, Collins CE. A scoping review of risk behaviour interventions in young men. BMC Public Health 2014; 14:957. [PMID: 25224717 PMCID: PMC4177699 DOI: 10.1186/1471-2458-14-957] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 09/08/2014] [Indexed: 01/01/2023] Open
Abstract
Background Young adult males commonly engage in risky behaviours placing them at risk of acute and chronic health conditions. The purpose of this scoping review was to provide an overview of existing literature, describing the interventions targeting risk behaviours in young adult males. Methods A search of seven electronic databases, grey literature and relevant journals reported in English language until May 2013 was conducted. All interventions that promoted healthy behaviours or reductions in risky behaviours to treat or prevent an associated health issue(s) in young adult males (17-35 years) in upper-middle and high-income countries were included. For inclusion the appropriate age range had to be reported and the sample had to be young adult male participants only or the outcomes reported with stratification by age and/or sex to include young adult males. Risk behaviours included: physical inactivity, poor diet, alcohol use, tobacco smoking, recreational drug use, unsafe sexual behaviours, tanning/sun exposure, violence, unsafe vehicle driving, gambling and self-harm. Results The search strategy identified 16,739 unique citations and the full-text of 1149 studies were retrieved and screened with 100 included studies focussed on: physical inactivity (27%), alcohol use (25%), unsafe sexual behaviour (21%), poor diet (5%), unsafe vehicle driving (5%), tobacco smoking (4%), recreational drug use (2%), and tanning/sun exposure (1%) with no relevant studies targeting violence, gambling or self-harm. Also 10% of the studies targeted multiple risk behaviours. The most common study design was randomized controlled trials (62%). Face-to-face was the most common form of intervention delivery (71%) and the majority were conducted in university/college settings (46%). There were 46 studies (46%) that included young adult male participants only, the remaining studies reported outcomes stratified by age and/or sex. Conclusion Risk behaviours in young men have been targeted to some extent, but the amount of research varies across risk behaviours. There is a need for more targeted and tailored interventions that seek to promote healthy behaviours or decrease risky behaviours in young men. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-957) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan Campus, Newcastle, Australia.
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Mediators of behavior change resulting from a sexual risk reduction intervention for STI patients, Cape Town, South Africa. J Behav Med 2014; 38:194-203. [PMID: 25179265 DOI: 10.1007/s10865-014-9591-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 08/05/2014] [Indexed: 10/24/2022]
Abstract
Theory-based sexual risk reduction interventions are often demonstrated effective, but few studies have examined the mechanisms that mediate their behavior changes. In addition, critical contextual factors, such as alcohol use, are often not accounted for by social cognitive theories and may add to the explanatory value of intervention effects. The purpose of this study is to examine the underlying mechanisms driving condom use following a brief sexual risk reduction intervention grounded in the information, motivation, behavioral skills (IMB) model of behavior change. We examined IMB theoretical constructs and alcohol-related contextual factors as potential mediators in separate models. Patients (n = 617) from an STI clinic in Cape Town, South Africa were randomly assigned to either a brief risk reduction intervention or an education-only control condition. We assessed IMB, and alcohol-related variables at baseline, 3, 6, 9, and 12 months and modeled IMB constructs and alcohol-related factors as mediators of behavior change. Results of growth-curve mediational modeling showed that 1 year after counseling, the intervention indirectly affected sexual risk behavior through alcohol-related constructs, but not IMB constructs. Alcohol use and related factors play critical roles in explaining HIV and STI risk reduction intervention effects. Interventions that directly address alcohol use as a factor in sexual risk behavior and behavior change should be the focus of future research.
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Bana A, Bhat VG, Godlwana X, Libazi S, Maholwana Y, Marafungana N, Mona K, Mbonisweni AM, Mbulawa N, Mofuka J, Mohlajoa NA, Nondula NN, Qubekile Y, Ramnaran B. Knowledge, attitudes and behaviours of adolescents in relation to STIs, pregnancy, contraceptive utilization and substance abuse in the Mhlakulo region, Eastern Cape. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2010.10873959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Hutton HE, McCaul ME, Norris J, Valliant JD, Abrefa-Gyan T, Chander G. Sex-Related Alcohol Expectancies Among African American Women Attending an Urban STI Clinic. JOURNAL OF SEX RESEARCH 2014; 52:580-589. [PMID: 25110958 PMCID: PMC4324376 DOI: 10.1080/00224499.2014.931336] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
African American women are disproportionately affected by human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and sexually transmitted infections (STIs). Alcohol use is a significant risk factor for HIV/STI acquisition. Sex-related alcohol expectancies (SRAEs) may partially account for alcohol-related risky sexual behaviors. Using qualitative interviews we explored the link between alcohol use and risky sex among 20 African American women attending an STI clinic who had consumed four or more alcoholic drinks per drinking day (binge drinking) and/or reported vaginal or anal sex while under the influence of alcohol. Four SRAEs emerged, which we named drink for sexual desire, drink for sexual power, drink for sexual excuse, and drink for anal sex. While the desire SRAE has been documented, this study identified three additional SRAEs not currently assessed by expectancy questionnaires. These SRAEs may contribute to high-risk sex when under the influence of alcohol and suggests the importance of developing integrated alcohol-sexual risk reduction interventions for high-risk women.
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Affiliation(s)
- Heidi E. Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287 USA
| | - Mary E. McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287 USA
| | - Jeanette Norris
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA 98105 USA
| | - Julia D. Valliant
- Illinois Children's Environmental Health Research Center, and Family Resiliency Center, University of Illinois, Urbana-Champagne, Urbana, IL 61801 USA
| | - Tina Abrefa-Gyan
- School of Social Work, University of Maryland, Baltimore, Baltimore, MD 21201 USA
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
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Tsitsika A, Andrie E, Deligeoroglou E, Tzavara C, Sakou I, Greydanus D, Papaevangelou V, Tsolia M, Creatsas G, Bakoula C. Experiencing sexuality in youth living in Greece: contraceptive practices, risk taking, and psychosocial status. J Pediatr Adolesc Gynecol 2014; 27:232-9. [PMID: 25016561 DOI: 10.1016/j.jpag.2013.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 11/06/2013] [Accepted: 11/11/2013] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE To assess initiation of sexual activity and contraception methods used among Greek adolescents. To determine the association of adolescents' emotional and behavioral status with their sexual activity. DESIGN A descriptive cross-sectional survey was conducted. SETTING, PARTICIPANTS The population (N = 1074, age 14-16) consisted of a random sample, stratified according to locality and population density, of 20 public junior high and high schools located in the urban district of Athens, Greece. INTERVENTIONS Anonymous self-reported questionnaires were used to assess sexual activity choices and contraception methods. The Youth Self-Report questionnaire was used to evaluate the psychosocial competencies and difficulties of Greek adolescents. MEASURES Analyses included frequencies with chi-square tests and multivariate logistic regression analysis. MAIN OUTCOME Factors that may influence sexual engagement of Greek adolescents were assessed. RESULTS Of the adolescents who completed the questionnaire 21.8% reported having experienced sexual intercourse. The male/female ratio was 3/1 (P < .001) and the mean age of sexual debut was 14.5 ± 0.9 years. Condoms were the most preferred contraceptive method (79.9%), followed by withdrawal (38.9%). Emergency contraception was used by 9.6% of participants. Adolescents with separated, divorced or with a deceased parent, and non-Greek nationality have higher possibility of being sexually active. Adolescents who reported sexual intercourse had significantly higher score of thought problems (β = 1.07, SE = 0.35, P = .002), attention difficulties (β = 0.67, SE = 0.29, P = .022), delinquent behavior problems (β = 2.37, SE = 0.34, P < .001), aggressive behavior (β = 1.97, SE = 0.48, P < .001), and externalizing problems (β = 4.18, SE = 0.78, P < .001). CONCLUSIONS Engagement in sexual activities was significantly associated with psychosocial difficulties among adolescents living in Greece.
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Affiliation(s)
- Artemis Tsitsika
- Adolescent Health Unit, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.
| | - Elisabeth Andrie
- Adolescent Health Unit, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Efthymios Deligeoroglou
- Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, University of Athens, Athens, Greece
| | - Chara Tzavara
- Adolescent Health Unit, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Irene Sakou
- Adolescent Health Unit, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Donald Greydanus
- Department of Pediatrics School of Medicine, Western Michigan University, Kalamazoo, MI
| | - Vassiliki Papaevangelou
- Second Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Mariza Tsolia
- Second Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - George Creatsas
- Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, University of Athens, Athens, Greece
| | - Chryssa Bakoula
- Second Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
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Loganantharaj N, Nichols WA, Bagby GJ, Volaufova J, Dufour J, Martin DH, Nelson S, Amedee AM. The effects of chronic binge alcohol on the genital microenvironment of simian immunodeficiency virus-infected female rhesus macaques. AIDS Res Hum Retroviruses 2014; 30:783-91. [PMID: 24902876 DOI: 10.1089/aid.2014.0065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Alcohol abuse is a widespread problem among those at risk for and living with HIV and can impact transmission and disease progression. In this study we sought to use the simian immunodeficiency virus (SIV)-macaque model to evaluate the immunological and virological changes in the genital microenvironment of females exposed to chronic alcohol. Female rhesus macaques were treated with alcohol (n=6) or isocaloric sucrose (n=6) for 3 months and then inoculated with SIVmac251. To assess the effects of chronic alcohol on SIV disease and the genital microenvironment, we quantified plasma and genital SIV levels, measured inflammatory cells in genital fluids, and characterized microbial flora by gram stains over 10 weeks post-SIV infection. Following 3 months of alcohol/sucrose treatment, significant differences were observed in the vaginal microenvironment of alcohol-treated animals as compared to controls. Microbial flora of alcohol-treated animals had decreased levels of lactobacillus morphotypes and increased levels of gram-positive cocci relative to sucrose controls. Alcohol-treated animals were also more likely to have white blood cells in vaginal fluids prior to SIV inoculation, which persisted through viral set point. Similar levels of cell-free SIV were observed in plasma and vaginal fluids of both groups, but alcohol-treated animals had a higher incidence and levels of cell-associated SIV shed in vaginal secretions. Chronic alcohol treatment negatively impacts the genital microenvironment prior to and over the course of SIV infection and may increase the risk of genital virus shedding and transmission.
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Affiliation(s)
- Nisha Loganantharaj
- Department of Microbiology, Immunology, and Parasitology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Whitney A. Nichols
- Department of Microbiology, Immunology, and Parasitology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Gregory J. Bagby
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Julia Volaufova
- Biostatistics Program, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Jason Dufour
- Division of Veterinary Medicine, Tulane National Primate Research Center, Covington, Louisiana
| | - David H. Martin
- Department of Internal Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Steve Nelson
- Department of Internal Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Angela M. Amedee
- Department of Microbiology, Immunology, and Parasitology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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Goodman-Meza D, Pitpitan EV, Semple SJ, Wagner KD, Chavarin CV, Strathdee SA, Patterson TL. Hazardous drinking and HIV-risk-related behavior among male clients of female sex workers in Tijuana, Mexico. Am J Addict 2014; 23:502-9. [PMID: 25066863 DOI: 10.1111/j.1521-0391.2014.12138.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 02/14/2014] [Accepted: 04/12/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Male clients of female sex workers (FSWs) are at high risk for HIV. Whereas the HIV risks of alcohol use are well understood, less is known about hazardous alcohol use among male clients of FSWs, particularly in Mexico. We sought to identify risk factors for hazardous alcohol use and test associations between hazardous alcohol use and HIV risk behavior among male clients in Tijuana. METHOD Male clients of FSWs in Tijuana (n = 400) completed a quantitative interview in 2008. The AUDIT was used to characterize hazardous alcohol use. Multivariate logistic regression was used to determine independent associations of demographic and HIV risk variables with hazardous alcohol use (vs. non-hazardous). RESULTS Forty percent of our sample met criteria for hazardous alcohol use. Variables independently associated with hazardous drinking were reporting any sexually transmitted infection (STI), having sex with a FSW while under the influence of alcohol, being younger than 36 years of age, living in Tijuana, and ever having been jailed. Hazardous drinkers were less likely ever to have been deported or to have shared injection drugs. DISCUSSION AND CONCLUSIONS Hazardous alcohol use is associated with HIV risk, including engaging in sex with FSWs while intoxicated and having an STI among male clients of FSWs in Tijuana. SCIENTIFIC SIGNIFICANCE We systematically described patterns and correlates of hazardous alcohol use among male clients of FSWs in Tijuana, Mexico. The results suggest that HIV/STI risk reduction interventions must target hazardous alcohol users, and be tailored to address alcohol use.
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Affiliation(s)
- David Goodman-Meza
- Division of Global Public Health, Department of Medicine, University of California at San Diego, La Jolla, California
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132
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Francis SC, Ao TT, Vanobberghen FM, Chilongani J, Hashim R, Andreasen A, Watson-Jones D, Changalucha J, Kapiga S, Hayes RJ. Epidemiology of curable sexually transmitted infections among women at increased risk for HIV in northwestern Tanzania: inadequacy of syndromic management. PLoS One 2014; 9:e101221. [PMID: 25025338 PMCID: PMC4099080 DOI: 10.1371/journal.pone.0101221] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 06/04/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Curable, non-viral pathogens account for a significant burden of sexually transmitted infections (STIs), and there is established evidence that STIs increase both HIV acquisition and transmission. We investigated the prevalence, trends, and factors associated with Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Treponema pallidum, and the performance of syndromic management, among a cohort of women working in bars, hotels, and other food and recreational facilities near large-scale mines in northwestern Tanzania. METHODS HIV-negative women aged 18-44 years (N = 966) were enrolled and followed for 12 months in a microbicides feasibility study. We collected sociodemographic and behavioural data, performed clinical examinations, and tested for STIs, at enrolment and 3-monthly. Risk factors for STIs were investigated using logistic regression models with random effects. Sensitivity, specificity and predictive values of syndromic management were calculated. RESULTS At enrolment, the prevalences of C. trachomatis, N. gonorrhoeae, T. vaginalis, and high-titre active syphilis were 111/956 (12%), 42/955 (4%), 184/945 (19%) and 46/965 (5%), respectively. There were significant decreases over time for C. trachomatis and T. vaginalis (OR trend per month: 0.94 [95% CI 0.91, 0.97]; and 0.95 [0.93, 0.98], respectively; both p<0.001). The majority of these infections were not diagnosed by the corresponding syndrome; therefore, most participants were not treated at the diagnosis visit. Syndromic management was poorly predictive of laboratory-diagnosed infections. We identified a number of risk factors for STIs, including low educational level, some sexual behaviours, and ever having been pregnant. CONCLUSIONS This analysis demonstrates that the prevalences of curable STIs are high among women who work in food and recreational facilities in northwestern Tanzania. Most of these infections are missed by syndromic management. Accurate and affordable rapid-point-of-care tests and innovative interventions are needed to reduce the burden of STIs in this population which is at increased risk for HIV.
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Affiliation(s)
- Suzanna C. Francis
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Trong T. Ao
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Fiona M. Vanobberghen
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Joseph Chilongani
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- National Institute for Medical Research, Mwanza, Tanzania
| | - Ramadhan Hashim
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Aura Andreasen
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Deborah Watson-Jones
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Saidi Kapiga
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Richard J. Hayes
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
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133
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Anderson DM, Pörtner CC. High School Dropouts and Sexually Transmitted Infections. SOUTHERN ECONOMIC JOURNAL 2014; 81:113-134. [PMID: 25705058 PMCID: PMC4335724 DOI: 10.4284/0038-4038-2012.195] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
People who drop out of high school fare worse in many aspects of life. We analyze the relationship between dropping out of high school and the probability of contracting a sexually transmitted infection (STI). Previous studies on the relationship between dropout status and sexual outcomes have not empirically addressed unobserved heterogeneity at the individual level. Using fixed effects estimators, we find evidence supporting a positive relationship between dropping out of high school and the risk of contracting an STI for females. Furthermore, we present evidence that illustrates differences between the romantic partners of dropouts versus enrolled students. These differences suggest that female dropouts may be more susceptible to contracting STIs because they partner with significantly different types of people than non-dropouts. Our results point to a previously undocumented benefit of encouraging those at risk of dropping out to stay in school longer.
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Affiliation(s)
- D Mark Anderson
- Department of Agricultural Economics and Economics Montana State University
| | - Claus C Pörtner
- Department of Economics Albers School of Business and Economics Seattle University & Center for Studies of Demography and Ecology University of Washington
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134
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Scott-Sheldon LAJ, Carey KB, Carey MP, Cain D, Simbayi LC, Kalichman SC. Alcohol use disorder, contexts of alcohol use, and the risk of HIV transmission among South African male patrons of shebeens. Drug Alcohol Depend 2014; 140:198-204. [PMID: 24854966 PMCID: PMC4079048 DOI: 10.1016/j.drugalcdep.2014.04.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 04/23/2014] [Accepted: 04/24/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND Shebeens in South Africa are settings in which alcohol use and sexual behavior often co-occur. The prevalence of alcohol use disorder (AUD), and the association between AUD, situations and settings, and sexual risk behavior, in shebeens remains unknown. METHODS Men (n=763; mean age=30; 98% Black African) were recruited from townships in Cape Town, South Africa and completed a self-administered survey that assessed alcohol use, sexual risk behaviors, and situations and settings of alcohol use. The Alcohol Use Disorder and Associated Disabilities Interview Schedule DSV-IV Version (AUDADIS-IV) was used to identify the likelihood of AUD. Bivariate regression analyses assessed whether screening for AUD predicted sexual risk behaviors. Multivariate regression analyses examined whether AUD and/or situations/settings predicted risk behaviors. RESULTS Nearly two-thirds of men (62%) endorsed sufficient criteria for AUD; 25%, 17%, and 20% were classified as having a mild, moderate, or severe AUD, respectively. AUD was associated with HIV risk such that men with AUD reported more unprotected sex than men without AUD. Analyses indicated that (a) individual (i.e., AUD) and (b) settings (i.e., frequency of having sex with a partner in a shebeen, tavern, or bottle store) interacted to predict unprotected sex. CONCLUSIONS The prevalence of AUD among shebeen patrons was high and was associated with unprotected sex. Findings suggest the need to integrate both individual and situational/setting factors to prevent HIV among patrons of shebeens.
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Affiliation(s)
- Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI 02906, United States; Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI 02912, United States.
| | - Kate B Carey
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, United States
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI 02906, United States; Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI 02912, United States
| | - Demetria Cain
- Department of Psychology, University of Connecticut, Storrs, CT 06269-1020, United States
| | - Leickness C Simbayi
- HIV/AIDS, STIs, and TB (HAST), Human Sciences Research Council, Cape Town 8000, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, Groote Schuur Hospital, Observatory 7925, South Africa
| | - Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs, CT 06269-1020, United States
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135
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Staras SAS, Livingston MD, Christou AM, Jernigan DH, Wagenaar AC. Heterogeneous population effects of an alcohol excise tax increase on sexually transmitted infections morbidity. Addiction 2014; 109:904-12. [PMID: 24450730 PMCID: PMC4013225 DOI: 10.1111/add.12493] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/24/2013] [Accepted: 01/13/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Alcohol taxes reduce population-level excessive alcohol use and alcohol-related morbidity and mortality, yet little is known about the distribution of the effects of alcohol taxation across race/ethnicity and age subgroups. We examined the race/ethnicity- and age group-specific effects of an excise alcohol tax increase on a common and routinely collected alcohol-related morbidity indicator, sexually transmitted infections. METHODS We used an interrupted time series design to examine the effect of a 2009 alcohol tax increase in Illinois, USA on new cases of two common sexually transmitted infections (chlamydia and gonorrhea) reported to the US National Notifiable Disease Surveillance System from January 2003 to December 2011 (n = 108 repeated monthly observations). We estimated the effects of the tax increase on infection rates in the general population and within specific race/ethnicity and age subgroups using mixed models accounting for temporal trends and median income. RESULTS Following the Illinois alcohol tax increase, state-wide rates of gonorrhea decreased 21% [95% confidence Interval (CI) = -25.7, -16.7] and chlamydia decreased 11% [95% CI = -17.8, -4.4], resulting in an estimated 3506 fewer gonorrhea infections and 5844 fewer chlamydia infections annually. The null hypothesis of homogenous effects by race/ethnicity and age was rejected (P < 0.0001). Significant reductions were observed among non-Hispanic blacks: gonorrhea rates decreased 25.6% (95% CI = -30.0, -21.0) and chlamydia rates decreased 14.7% (95% CI = -20.9, -8.0). Among non-Hispanics, point estimates suggest decreases were highest among 25-29-year-olds. CONCLUSIONS Increased alcohol taxes appear to reduce sexually transmitted infections, especially among subpopulations with high disease burdens, such as non-Hispanic blacks.
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Affiliation(s)
- Stephanie A S Staras
- Department of Health Outcomes and Policy, Institute for Child Health Policy, College of Medicine, University of FloridaGainesville, FL, USA
| | - Melvin D Livingston
- Department of Health Outcomes and Policy, Institute for Child Health Policy, College of Medicine, University of FloridaGainesville, FL, USA
| | - Alana M Christou
- Department of Health Outcomes and Policy, Institute for Child Health Policy, College of Medicine, University of FloridaGainesville, FL, USA
| | - David H Jernigan
- Department of Health, Behavior and Society, Bloomberg School of Public Health, The Johns Hopkins UniversityBaltimore, MD, USA
| | - Alexander C Wagenaar
- Department of Health Outcomes and Policy, Institute for Child Health Policy, College of Medicine, University of FloridaGainesville, FL, USA
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Roberts B, Murphy A, Chikovani I, Makhashvili N, Patel V, McKee M. Individual and community level risk-factors for alcohol use disorder among conflict-affected persons in Georgia. PLoS One 2014; 9:e98299. [PMID: 24865450 PMCID: PMC4035315 DOI: 10.1371/journal.pone.0098299] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 04/30/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The evidence on alcohol use disorder among conflict-affected civilian populations remains extremely weak, despite a number of potential risk-factors. The aim of this study is to examine patterns of alcohol use disorder among conflict-affected persons in the Republic of Georgia. METHODS A cross-sectional survey of 3600 randomly selected internally displaced persons (IDPs) and former IDPs. Two alcohol use disorder outcomes were measured: (i) having at least hazardous alcohol use (AUDIT score ≥ 8); (ii) episodic heavy drinking (consuming >60 grams of pure alcohol per drinking session at least once a week). Individual level demographic and socio-economic characteristics were also recorded, including mental disorders. Community level alcohol environment characteristics relating to alcohol availability, marketing and pricing were recorded in the respondents' communities and a factor analysis conducted to produce a summary alcohol environment factor score. Logistic regression analyses examined associations between individual and community level factors with the alcohol use disorder outcomes (among men only). RESULTS Of the total sample, 71% of men and 16% of women were current drinkers. Of the current drinkers (N = 1386), 28% of men and 1% of women were classified as having at least hazardous alcohol use; and 12% of men and 2% of women as episodic heavy drinkers. Individual characteristics significantly associated with both outcomes were age and experiencing a serious injury, while cumulative trauma events and depression were also associated with having at least hazardous alcohol use. For the community level analysis, a one unit increase in the alcohol environment factor was associated with a 1.27 fold increase in episodic heavy drinking among men (no significant association with hazardous alcohol use). CONCLUSION The findings suggest potential synergies for treatment responses for alcohol use disorder and depression among conflict-affected populations in Georgia, as well as the need for stronger alcohol control policies in Georgia.
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Affiliation(s)
- Bayard Roberts
- European Centre on Health of Societies in Transition (ECOHOST), London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Adrianna Murphy
- European Centre on Health of Societies in Transition (ECOHOST), London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Nino Makhashvili
- Global Initiative on Psychiatry – Tbilisi, Georgia, Ilia State University, Tbilisi, Georgia
| | - Vikram Patel
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin McKee
- European Centre on Health of Societies in Transition (ECOHOST), London School of Hygiene and Tropical Medicine, London, United Kingdom
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137
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Cain D, Pitpitan EV, Eaton L, Carey KB, Carey MP, Mehlomakulu V, Harel O, Simbayi LC, Mwaba K, Kalichman SC. Collective efficacy and HIV prevention in South African townships. J Community Health 2014; 38:885-93. [PMID: 23660646 DOI: 10.1007/s10900-013-9694-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
South African townships have high HIV prevalence and a strong need for collective action to change normative sexual risk behaviors. This study investigated the relationship between perceptions of individuals about collective efficacy in the community's ability to prevent HIV and their personal HIV risk behaviors. Men (n = 1,581) and women (n = 718) completed anonymous surveys within four Black African Townships in Cape Town, South Africa from June 2008 to December 2010. Measures included demographics, alcohol use, attitudinal and behavioral norms, sexual health communications, and sexual risk behaviors. In multivariate logistic regressions, men were more likely to endorse collective efficacy if they were married, drank less often in alcohol serving establishments, believed that fewer men approve of HIV risk behaviors, talk more with others about HIV/AIDS, and had more sex partners in the past month. Women were more likely to endorse collective efficacy if they drank alcohol less often, talked more with others about HIV/AIDS, had more sex partners in the past month, but reported fewer unprotected sex acts in the past month. Community level interventions that strengthen collective efficacy beliefs will have to consider both protective and risk behaviors associated with believing that the community is ready and capable of preventing HIV.
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Affiliation(s)
- Demetria Cain
- Center for Health Intervention and Prevention, University of Connecticut, 2006 Hillside Road Unit 1248, Storrs, CT 06269, USA.
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138
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Wilson K, Albarracín D. Barriers to accessing HIV-prevention in clinic settings: Higher alcohol use and more sex partners predict decreased exposure to HIV-prevention counseling. PSYCHOL HEALTH MED 2014; 20:87-96. [PMID: 24684497 DOI: 10.1080/13548506.2014.902484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Understanding barriers to accepting HIV-prevention counseling among vulnerable populations is of critical importance, as prevention efforts can only have a public health impact if high-risk populations are willing to enroll. A correlational field study was conducted in a health care setting with a high-risk community sample (N = 350) to determine if number of sex partners and alcohol consumption predict acceptance of an invitation to take part in HIV-prevention counseling. Findings indicated that participants engaging in the least risky behavior (i.e. individuals reporting no alcohol consumption and few sex partners) were more likely to accept an offer to receive HIV-prevention counseling. Moreover, heavy drinking was associated with decreased exposure to HIV-prevention counseling, regardless of the number of sex partners reported (b = .12, p > .05). Given associations between heavy drinking and sexual risk taking, finding ways to increase exposure to HIV-prevention counseling programs among heavy drinkers could serve a vital public health function.
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Affiliation(s)
- Kristina Wilson
- a Annenberg School for Communication, University of Pennsylvania , Philadelphia , PA , USA
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139
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Epstein M, Manhart LE, Hill KG, Bailey JA, Hawkins JD, Haggerty KP, Catalano RF. Understanding the link between early sexual initiation and later sexually transmitted infection: test and replication in two longitudinal studies. J Adolesc Health 2014; 54:435-441.e2. [PMID: 24280303 PMCID: PMC3965628 DOI: 10.1016/j.jadohealth.2013.09.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 09/24/2013] [Accepted: 09/25/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Age at sexual initiation is strongly associated with sexually transmitted infections (STI); yet, prevention programs aiming to delay sexual initiation have shown mixed results in reducing STI. This study tested three explanatory mechanisms for the relationship between early sexual debut and STI: number of sexual partners, individual characteristics, and environmental antecedents. METHODS A test-and-replicate strategy was employed using two longitudinal studies: the Seattle Social Development Project (SSDP) and Raising Healthy Children (RHC). Childhood measures included pubertal age, behavioral disinhibition, and family, school, and peer influences. Alcohol use and age of sexual debut were measured during adolescence. Lifetime number of sexual partners and having sex under the influence were measured during young adulthood. Sexually transmitted infection diagnosis was self-reported at age 24. Early sex was defined as debut at <15 years. Path models were developed in SSDP evaluating relationships between measures, and were then tested in RHC. RESULTS The relationship between early sex and STI was fully mediated by lifetime sex partners in SSDP, but only partially in RHC, after accounting for co-occurring factors. Behavioral disinhibition predicted early sex, early alcohol use, number of sexual partners, and sex under the influence, but had no direct effect on STI. Family management protected against early sex and early alcohol use, whereas antisocial peers exacerbated the risk. CONCLUSIONS Early sexual initiation, a key mediator of STI, is driven by antecedents that influence multiple risk behaviors. Targeting co-occurring individual and environmental factors may be more effective than discouraging early sexual debut and may concomitantly improve other risk behaviors.
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Affiliation(s)
- Marina Epstein
- Social Development Research Group, School of Social Work, University of Washington, Seattle, Washington.
| | - Lisa E. Manhart
- Center for AIDS and STD, School of Public Health, University of Washington, Seattle
| | - Karl G. Hill
- Social Development Research Group, University of Washington, Seattle
| | | | - J. David Hawkins
- Social Development Research Group, University of Washington, Seattle
| | - Kevin P. Haggerty
- Social Development Research Group, University of Washington, Seattle
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Alcohol use, stigmatizing/discriminatory attitudes, and HIV high-risk sexual behaviors among men who have sex with men in China. BIOMED RESEARCH INTERNATIONAL 2014; 2014:143738. [PMID: 24795879 PMCID: PMC3985170 DOI: 10.1155/2014/143738] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 02/22/2014] [Indexed: 11/20/2022]
Abstract
Objective. This research was conducted to assess the correlates of alcohol consumption and HIV/AIDS-related stigmatizing and discriminatory attitudes among men who have sex with men (MSM) in Shandong province, China. Methods. A cross-sectional survey provided demographics, sexual behaviors, illicit drug use, alcohol consumptions, and service utilization. Results. Of 1,230 participants, 82.8% were single, 85.7% aged <35 years, 47.2% had college or higher education, and 11.7% drank alcohol >3 times per week in the past six months. The average total score of stigmatizing and discriminatory attitude was 37.4 ± 4.4. More frequent episodes of alcohol use were independently associated with higher levels of HIV/AIDS-related stigma and discrimination, unprotected anal sex, bisexual identity, multiple male sex partners, drug use, and lower levels of education. Expressing higher levels of HIV/AIDS-related stigmatizing and discriminatory attitudes was independently associated with alcohol use, unprotected male anal sex, bisexuals, more male sex partners, commercial sex with men, and non-receipt of peer education in the past year. Conclusion. HIV/AIDS-related stigmatizing and discriminatory attitudes are common and associated with alcohol use and unprotected sex among MSM. The finding highlights the needs to develop programs that would reduce HIV/AIDS-related stigmatizing and discriminatory attitudes and strengthen alcohol use prevention and risk reduction initiatives among MSM.
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141
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Hu X, Dodd VJ, Oliverio JC, Cook RL. Utilization of information and communication technology (ICT) among sexually transmitted disease clinics attendees with coexisting drinking problems. BMC Res Notes 2014; 7:178. [PMID: 24670037 PMCID: PMC3974195 DOI: 10.1186/1756-0500-7-178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 03/20/2014] [Indexed: 11/14/2022] Open
Abstract
Background Alcohol misuse remains a major risk factor for contracting sexually transmitted diseases (STDs) not typically addressed in STD clinic settings. Information and communication technology (ICT) can offer new avenues to deliver evidence-based screening and treatment for problematic drinking, however, few data exists regarding the utilization of ICT among STD clinic attendees with coexisting drinking problems. The objectives of this study are to identify STD clinics attendees with hazardous drinking, to examine socio-demographic factors associated with ICT use, and to explore individuals’ interests in engaging in ICT-based health interventions. Methods Cross-sectional questionnaires examining alcohol consumption and ICT use were administered to 396 persons attending two non-urban STD clinics. Descriptive statistics for ICT use were calculated for both hazardous drinkers and the entire sample. Multivariable logistic regression models among hazardous drinkers identified factors significantly associated with use of each kind of ICT. Results The mean age of the 396 participants was 25 years, 66% were females and 60% were African-Americans. One third of the sample met the criteria of hazardous drinking. ICT use in hazardous drinkers included 94% reporting having internet access at least monthly, 82% reporting having an email account, 85% reporting currently owning a cell phone, and 91% reporting use of any cell phone application. More than two thirds (73%) of hazardous drinkers were willing to play health-related video games during clinic waiting time, slightly higher than the entire sample (69%). Multivariable analyses indicated that younger age were significantly related to monthly internet use, and multifunction cell phone use, while being males and younger age were significantly associated with monthly video game playing. Conclusions Our study demonstrates commonality of ICT use among STD clinic attendees with hazardous drinking, indicating the viability of using ICT to assist screening and behavioural intervention for alcohol misuse in STD clinic settings. Future research is needed to demonstrate the effectiveness of ICT-based health behavioural interventions in the STD clinic settings or other venues that serve populations at high risk for substance abuse, HIV or other STDs.
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Affiliation(s)
- Xingdi Hu
- Department of Epidemiology, University of Florida, Gainesville, FL, USA.
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Alcohol use among Chinese men who have sex with men: an epidemiological survey and meta-analysis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:414381. [PMID: 24711993 PMCID: PMC3966324 DOI: 10.1155/2014/414381] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 01/12/2014] [Indexed: 12/26/2022]
Abstract
The HIV/AIDS epidemic among Chinese men who have sex with men (MSM) has become a significant public health concern. Knowledge of alcohol consumption in this population is limited. In this study, 1,155 Chinese MSM were surveyed to assess alcohol use and its correlates. A meta-analysis was also performed to aggregate pooled prevalence of current alcohol use. MSM who were unmarried (aOR: 1.87; 95% CI: 1.29-2.71) or unemployed/retired (aOR: 2.77; 95% CI: 1.73-4.45) were more likely to drink alcohol more than once per week. MSM who consumed alcohol more than once per week were more likely to use drug (P < 0.01), have sex with women (P < 0.01), have unprotected insertive (P = 0.04) or receptive (P = 0.03) anal sex with men, have more than 10 lifetime male sex partners (P < 0.01), predominantly practice insertive anal sex (P < 0.01), and trade sex for money (P < 0.01). Pooled overall alcohol use prevalence was 32%. Pooled prevalence for MSM who drank alcohol more than once per week and who drank alcohol before sex with male partners was 23%. Our findings provide the basis for further exploring the alcohol-HIV association and developing risk reduction interventions.
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143
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Differences in Sexual Health, Risk Behaviors, and Substance Use Among Women by Sexual Identity. Sex Transm Dis 2014; 41:194-9. [DOI: 10.1097/olq.0000000000000091] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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144
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Trecker MA, Waldner C, Jolly A, Liao M, Gu W, Dillon JAR. Behavioral and socioeconomic risk factors associated with probable resistance to ceftriaxone and resistance to penicillin and tetracycline in Neisseria gonorrhoeae in Shanghai. PLoS One 2014; 9:e89458. [PMID: 24586792 PMCID: PMC3929748 DOI: 10.1371/journal.pone.0089458] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 01/23/2014] [Indexed: 12/04/2022] Open
Abstract
Globally, incidence of Neisseria gonorrhoeae infection is once again the highest of the bacterial sexually transmitted infections. The bacterium can produce serious complications in those infected, and emerging resistance to third generation cephalosporins could usher in an era of potentially untreatable gonorrhea. This research aimed to identify risk factors for antibiotic resistant gonorrhea infection among clients at a Shanghai sexually transmitted infection clinic over two time periods, 2004-2005 and 2008-2011. Demographic and risk factor behavior data, and biological samples for antimicrobial resistance analysis, were collected. Statistical models were built to identify risk factors associated with probable resistance to ceftriaxone and resistance to penicillin and tetracycline. High levels of ciprofloxacin resistance (98%) in our sample precluded examining its risk factors; all isolates were susceptible to spectinomycin. Overall (P<0.001), chromosomal (P<0.001), and plasmid-mediated (P = 0.01) penicillin resistance decreased from the first to second period of the study. For tetracycline, chromosomal resistance decreased (P = 0.01) and plasmid-mediated resistance increased (P<0.001) between the first and second periods of study. In multi-level multivariable regression models, male gender (P = 0.03) and older age (P = 0.01) were associated with increased minimum inhibitory concentrations to ceftriaxone. Male gender (P = 0.03) and alcohol use (P = 0.02) were associated with increased odds of overall tetracycline resistance. Male gender was associated with increased odds of chromosomally-mediated tetracycline resistance (P = 0.04), and alcohol use was associated with increased odds of plasmid-mediated tetracycline resistance (P = 0.02). Additionally, individuals in middle-salary categories were found to have lower odds of plasmid-mediated resistance to tetracycline compared with those in the lowest salary category (P≤0.02). This study is one of the first to use multilevel analysis to consider the association between risk factors for gonorrhea infections and mechanisms of resistance to individual antibiotics. Such information is urgently needed to combat the growing threat of untreatable gonorrhea.
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Affiliation(s)
- Molly A. Trecker
- Vaccine and Infectious Disease Organization – International Vaccine Centre, Saskatoon, Saskatchewan, Canada
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Cheryl Waldner
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ann Jolly
- Centre for Infectious Disease Prevention and Control, Health Canada and Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Mingmin Liao
- Department of Microbiology and Immunology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Weiming Gu
- Shanghai Skin Disease and Sexually Transmitted Disease Hospital, Shanghai, China
| | - Jo-Anne R. Dillon
- Vaccine and Infectious Disease Organization – International Vaccine Centre, Saskatoon, Saskatchewan, Canada
- Department of Microbiology and Immunology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Choudhry V, Agardh A, Stafström M, Östergren PO. Patterns of alcohol consumption and risky sexual behavior: a cross-sectional study among Ugandan university students. BMC Public Health 2014; 14:128. [PMID: 24502331 PMCID: PMC3933239 DOI: 10.1186/1471-2458-14-128] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 01/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As reflected in elevated rates of sexually transmitted infections, there is a high prevalence of risky sexual behavior among Ugandan university students. It has been assumed that alcohol contributes to risky sexual behavior. However, perhaps owing to methodological issues, this relationship has found only mixed support in empirical research. The present study analyzes the association between alcohol use and risky sexual behavior at the global, situational, and event level among Uganda university students with sexual experience. METHODS A cross-sectional survey was carried out in 2010 among 1954 students at Mbarara University of Science and Technology, Uganda, using a self-administered questionnaire. Alcohol use was measured as consumption over the previous 12 months, during situations related to sexual activity and on the most recent occasion of sexual intercourse. Risky sexual behavior was defined as having two or more sexual partners in the previous 12 months or inconsistent condom use with new partners. Bivariate and multivariate logistic regression was performed to analyze the association between alcohol use and risky sexual behavior separately for males and females. RESULTS Even after adjusting for confounders, the odds ratio (OR) of having two or more sexual partners in the past year indicated a statistically significant association with alcohol use on all levels (global, situational, and event) for both males and females. The ORs of inconsistent condom use with a new partner were significant for males who often consumed alcohol in relation to sexual activity--even after adjusting for potential confounders (OR, 1.75; confidence interval, 1.01-3.08). The risk of inconsistent condom use with a new partner was twice as high for females who often consumed alcohol in relation to sexual activity, although this association was not statistically significant. CONCLUSIONS The study supports previous research that alcohol consumption is associated with having multiple sexual partners. Inconsistent condom use was associated with the situational use of alcohol in relation to sexual activity and was similar for both genders. Interventions to reduce alcohol-related risky sexual behavior should target both male and female drinkers, particularly subgroups of students, who often consume alcohol in relation to sexual activity.
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Affiliation(s)
- Vikas Choudhry
- Department of Clinical Sciences, Social Medicine and Global Health, Clinical Research Centre, Lund University, Jan Waldenströms gata 35, House 28, Floor 12, Malmö, Sweden.
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Muturi N. Alcohol consumption and reproductive health risks in rural Central Kenya. SEXUAL & REPRODUCTIVE HEALTHCARE 2014; 5:41-6. [PMID: 24814437 DOI: 10.1016/j.srhc.2014.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 01/15/2014] [Accepted: 01/19/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The goal of the current study is to explore the perceived reproductive health risks associated with alcoholism from the perspective of rural communities in Kenya where abuse of illicit liquor especially among men has become an epidemic. METHODS Data for the study were gathered qualitatively through focus groups among community members and in-depth interviews with opinion leaders and key informants who were selected through a snowball method. All recorded data were analyzed through constructivist and interpretive techniques, which started with a line-by-line examination of transcripts for identification of emerging themes. RESULTS Rural communities are aware of the lethal nature of the illicit liquor and the severe reproductive health problems associated with it among male consumers. Alcoholism also affects women's sexual and reproductive needs and is attributed to risky sexual behaviors in alcohol-discordant relationships, which puts them at a higher risk of HIV infection. CONCLUSIONS Results indicate a need to address alcoholism in rural Kenya as a public health problem focusing on education and understanding of the long-term health consequences. Addressing the impact on male reproductive health is crucial because it impacts the wider community. Given the complex relationship between alcohol abuse and HIV/AIDS, it is also important for prevention interventions to target married women and non-alcohol consumers. Furthermore, engaging communities will ensure development of culture- and gender-specific interventions. Such engagement requires facilitation of health practitioners for development of meaningful community-based initiatives.
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Affiliation(s)
- Nancy Muturi
- A.Q. Miller School of Journalism and Mass Communications, Kansas State University, Manhattan, KS 66506, United States.
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Epstein M, Bailey JA, Manhart LE, Hill KG, Hawkins JD. Sexual risk behavior in young adulthood: broadening the scope beyond early sexual initiation. JOURNAL OF SEX RESEARCH 2014; 51:721-30. [PMID: 24423058 PMCID: PMC4082430 DOI: 10.1080/00224499.2013.849652] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
A robust link between early sexual initiation and sexual risk-taking behavior is reported in previous studies. The relationship may not be causal, however, as the effect of common risk factors is often not considered. The current study examined whether early initiation was a key predictor of risky sexual behavior in the 20s and 30s, over and above co-occurring individual and environmental factors. Data were drawn from the Seattle Social Development Project, a longitudinal panel of 808 youth. Early predictors (ages 10 to 15) and sexual risk taking (ages 21 to 24 and 30 to 33) were assessed prospectively. Early sexual initiation (before age 15) was entered into a series of probit regressions that also included family, neighborhood, peer, and individual risk factors. Although a positive bivariate relation between early sexual initiation and sexual risk taking was observed at both ages, the link did not persist when co-occurring risk factors were included. Behavioral disinhibition and antisocial peer influences emerged as the strongest predictors of sexual risk over and above early sexual initiation. These results suggest that early sexual initiation must be considered in the context of common antecedents; public health policy aimed at delaying sexual intercourse alone is unlikely to substantially reduce sexual risk behavior in young adulthood.
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Affiliation(s)
- Marina Epstein
- Social Development Research Group, University of Washington, Seattle
| | | | - Lisa E. Manhart
- Center for AIDS and STD, School of Public Health, University of Washington, Seattle
| | - Karl G. Hill
- Social Development Research Group, University of Washington, Seattle
| | - J. David Hawkins
- Social Development Research Group, University of Washington, Seattle
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Alcohol misuse and psychosocial outcomes in young adulthood: results from a longitudinal birth cohort studied to age 30. Drug Alcohol Depend 2013; 133:513-9. [PMID: 23931962 DOI: 10.1016/j.drugalcdep.2013.07.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 06/13/2013] [Accepted: 07/13/2013] [Indexed: 11/23/2022]
Abstract
PURPOSE This study examined the associations between measures of alcohol abuse/dependence symptoms and a range of psychosocial outcomes from ages 21 to 30 in a New Zealand birth cohort. METHODS Outcome measures included measures of: criminal offending, family violence and relationship instability, sexual risk-taking and consequences, mental health, and other adverse health and adjustment outcomes. Bivariate associations between a three-level classification of alcohol misuse (no symptoms, subclinical level of symptoms, met criteria for alcohol dependence) and each outcome during the period 21-30 years were computed using Generalised Estimating Equation models. These associations were then adjusted for non-observed sources of confounding using conditional fixed effects regression modelling, augmented by time-dynamic covariate factors. For both sets of models estimates of the attributable risk (AR) were computed. RESULTS There were statistically significant (p<.05) bivariate associations between alcohol misuse and each of the fifteen outcome measures, with estimates of the AR ranging from 7.4% to 46.5%. Adjustment for non-observed fixed effects generally reduced the magnitude of these associations; however, after adjustment, 12 of the 15 associations remained statistically significant (p<.05). Estimates of the AR after adjustment for fixed effects ranged from 3.6% to 44.3%. CONCLUSIONS The results suggest that there are pervasive and persistent linkages between alcohol misuse and a range of adverse psychosocial outcomes. A reduction in levels of alcohol misuse amongst individuals of this age group could reduce substantially the overall level of personal and societal cost of hazardous levels of alcohol consumption.
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Brook G, Bacon L, Evans C, McClean H, Roberts C, Tipple C, Winter AJ, Sullivan AK. 2013 UK national guideline for consultations requiring sexual history taking. Clinical Effectiveness Group British Association for Sexual Health and HIV. Int J STD AIDS 2013; 25:391-404. [PMID: 24285601 DOI: 10.1177/0956462413512807] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gary Brook
- North West London Hospitals NHS Trust, London, UK
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