Predictors of high-risk behavior in unmarried American women: adolescent environment as risk factor

Parents as partners in adolescent HIV prevention in Eastern and Southern Africa: an evaluation of the current United Nations' approach

The United Nations's (UN) sustainable development goals (SDGs) include the target (3.3) of ending the HIV/AIDS epidemic by 2030. A major challenge in this regard is to curb the incidence of HIV among adolescents, the number two cause of their death in Africa. In Eastern and Southern Africa, they are mainly infected through heterosexual transmission. Research findings about parental influence on the sexual behavior of their adolescent children are reviewed and findings indicate that parental communication, monitoring and connectedness contribute to the avoidance of risky sexual behavior in adolescents. This article evaluates the extent to which these three dimensions of parenting have been factored in to current HIV prevention recommendations relating to adolescent boys and girls. Four pertinent UN reports are analyzed and the results used to demonstrate that the positive role of parents or primary caregivers vis-à-vis risky sexual behavior has tendentially been back-grounded or even potentially undermined. A more explicit inclusion of parents in adolescent HIV prevention policy and practice is essential - obstacles notwithstanding - enabling their indispensable partnership towards ending an epidemic mostly driven by sexual risk behavior. Evidence from successful or promising projects is included to illustrate the practical feasibility and fruitfulness of this approach.

HIV knowledge and risky sexual behavior among men in Rwanda

Introduction

New infections of Human Immunodeficiency Virus (HIV) remain a big problem in many countries. Different interventions have been implemented to improve the general knowledge of HIV, with the hypothesis that increasing HIV knowledge will reduce risky sexual behavior (RSB). However, HIV knowledge may not necessarily reduce RSB. This study explores HIV knowledge and its effect on RSB.

Methods

The study used data from the 2005 and 2010 Rwanda Demographic and Health Surveys to analyze the association between HIV risk factors and two types of RSB (having two or more partners in the past 12 months; and among those with two or more partners, not using a condom at last sex) and the association between HIV knowledge and those RSB. Multivariate logistic regression was used to determine predictors of RSB.

Results

Among 2,773 men in 2005 and 3,772 men in 2010, 5% and 7% respectively reported having two or more sexual partners. Among them, 93% in 2005 and 74% in 2010 did not use a condom at the last sex. Between 2005 and 2010, knowledge of the protective effect of having just one uninfected faithful partner, and basic knowledge of HIV decreased. Knowledge of the protective effect of using condoms increased from 90% to 94%. However, HIV knowledge was not associated with either type of RSB.

Conclusion

In setting up policies and strategies related to HIV prevention, policymakers should consider that focusing on HIV knowledge is not sufficient in itself.

Associations between early first sexual intercourse and later sexual and reproductive outcomes: a systematic review of population-based data

The assumption that early sexual debut leads to adverse outcomes has been used as justification for sexual health interventions and policies aimed at delaying sexual initiation, yet research in the area has been limited. This review identified and synthesized published literature on the association between early first sexual intercourse and later sexual/reproductive outcomes. Literature searches were conducted in Medline, Embase, PsycINFO, and Current Contents. In all, 65 citations met the selection criteria (industrialized, population-based studies). By far the most common sexual behavior to have been investigated has been sexual partners. Studies consistently reported early first intercourse to be associated with more recent, lifetime, and concurrent sexual partners. Early initiators were also more likely to participate in a wider range of sexual practices and report increased sexual satisfaction (among men). Furthermore, early first intercourse, in some studies, was shown to increase the risk of teen pregnancies, teen births, and having an abortion, while findings on STIs and contraceptive use have been mixed. These findings, however, must be interpreted with caution due to methodological problems and limitations present in the research, including a lack of consensus on what constitutes early sexual intercourse and inconsistencies and problems with analyses.

The influence of religion on sexual HIV risk

This systematic review examines the relationship between religion and sexual HIV risk behavior. It focuses primarily on how studies have conceptualized and defined religion, methodologies, and sexual risk outcomes. We also describe regions where studies were conducted and mechanisms by which religion may be associated with sexual risk. We included 137 studies in this review, classifying them as measuring: (1) only religious affiliation (n = 57), (2) only religiosity (n = 48), and (3) both religious affiliation and religiosity (n = 32). A number of studies identified lower levels of sexual HIV risk among Muslims, although many of these examined HIV prevalence rather than specific behavioral risk outcomes. Most studies identified increased religiosity to be associated with lower levels of sexual HIV risk. This finding persists but is weaker when the outcome considered is condom use. The paper reviews ways in which religion may contribute to increase and reduction in sexual HIV risk, gaps in research, and implications for future research on religion and HIV.

The Age of Initiation of Drug Use and Sexual Behavior May Influence Subsequent HIV Risk Behavior: A Systematic Review

Researchers examining injection drug users (IDUs) in drug treatment have been trying for decades to determine the optimal way to intervene to prevent the transmission and spread of human immunodeficiency virus (HIV) in this population. Although efficacious HIV risk reduction interventions are widely available, questions remain about what specific factors are most related to HIV risk behavior and defined as unprotected sexual activity and/or high risk drug use. This review involved an evaluation of the research literature in order to better understand the association between drug use and sexual behavior debut on HIV risk behavior. Findings suggest that drug use debut and sexual behavior debut may be related to subsequent HIV risk behavior. Evidence to date implies that intervening at an earlier age to assist youth to avoid or delay these high risk behaviors may be an additional means of reducing subsequent HIV risk.

The number of sexual partners and health-risking sexual behavior: prediction from high school entry to high school exit

Precursors to adolescent health-risking sexual behavior (HRSB) were examined in a normative sample of 373 adolescents (48.0% female, n = 178). Using a variable-oriented approach, we regressed the number of sexual partners at high school exit (age 17) on parental monitoring, association with delinquent peers, romantic relationship status, problem behavior, physical maturity, and tobacco and alcohol use at high school entry (age 14); all emerged as significant predictors except alcohol use and physical maturity (we found sex differences in physical maturity and romantic relationship status, with females being more advanced in both areas). Sexual experimentation at high school entry served to partially or fully mediate the impact of these factors. A person-oriented approach, using a broader measure of HRSB, found three subgroups of adolescents: abstainers, low-risk-takers, and high-risk-takers. Results predicting membership in these groups generally followed those from the variable-oriented analysis. Implications for the prevention of HRSB and future research directions are discussed.

Testing the role of adolescent sexual initiation in later-life sexual risk behavior: a longitudinal twin design

The consistent association between adolescent sexual initiation (ASI) and risky adult sexual behavior (RASB) has generally been assumed to indicate that ASI has a causal effect on RASB; consequently, it is assumed that delaying ASI will reduce RASB. Yet the ASI-RASB association might be better accounted for by some third variable. We evaluated the causal role of ASI (initiation of oral, anal, or vaginal sex at or before age 16) in influencing RASB in a longitudinal sample of 2,173 twins (followed from ages 11 to 24 or from ages 17 to 29) using two methods: the discordant-twin design and the propensity-score design. The former controlled for unmeasured genetic and shared environmental factors, and the latter controlled for measured nonshared environmental factors. We replicated the link between ASI and RASB reported in previous research, but results from the discordant-twin and propensity-score analyses suggested that this association is better explained by common genetic or environmental risk factors than as a causal effect. These findings suggest that preventing ASI is unlikely to reduce RASB.

Developmental Precursors of Number of Sexual Partners from Age 16 to 22

This study examines family and child characteristics, parent and peer relationships, and early adolescent behavior as statistical predictors of trajectories of number of sexual partners from mid-adolescence through early adulthood using data from 527 participants in the Child Development Project. Early adolescent developmental antecedents accounted for modest variance in number of sexual partners. Latent growth models revealed that African American race, more advanced pubertal development, lower parental monitoring knowledge, association with more deviant peers, and lower GPA in early adolescence each predicted having more sexual partners at age 16. In addition, non-African American race, lower child IQ, higher parental monitoring knowledge, and lower early adolescent internalizing problems each was associated with a higher rate of growth in number of sexual partners over time at the ages following 16. Latent growth mixture modeling identified subgroups with distinct trajectories of involvement with sexual partners that were associated with family and child characteristics, parent and peer relationships, and behavior in early adolescence.

Factors associated with condom use in women from an urban area in southern Brazil

This study investigated the prevalence of factors associated with condom use during last sexual intercourse in 15-49-year-old women in a probabilistic sample from the urban area of Pelotas, southern Brazil. A questionnaire administered by an interviewer, investigating socioeconomic characteristics and habits, and another (self-administered) questionnaire on sexual behavior-related variables were used. Poisson regression, following a hierarchical model, was used for data analysis. 1,543 women were included, and losses and refusals amounted to 3.5%. Prevalence of condom use in last sexual intercourse was 28.0%. Condom use was positively associated with younger age, greater schooling, non-white color, single marital status, and greater number of sex partners in the previous three months. This suggests that the group most vulnerable to STDs/AIDS due to lack of condom use is white, adult women, in stable unions, with fewer sexual partners.

Neighborhood context and racial differences in early adolescent sexual activity

Evidence suggests that African American youths initiate sexual activity at earlier ages than do European American or Latino youths. Using data from a multilevel study in Chicago, we developed and tested a neighborhood-based model of the timing of first adolescent intercourse that emphasizes the impact of neighborhood structural disadvantage and collective efficacy on early sexual activity (at ages 11 to 16). In turn, we explored the extent to which neighborhood factors account for racial differences in the timing of first intercourse. The findings indicate that demographic background, family processes, peer influences, and developmental risk factors account for about 30% of the baseline increased likelihood of early sexual onset for African American youths compared with European American youths. However, a significant residual racial difference remained even after we considered a host of micro-level factors. Neighborhood-level concentrated poverty largely explained this residual racial difference. Collective efficacy also independently contributed to the delay of sexual onset. No significant baseline difference in age of sexual initiation was found between Latino and European American youths.

Self-Reported Symptoms of Reproductive Tract Infections Among Rural Women in Hainan, China: Prevalence Rates and Risk Factors

OBJECTIVES AND GOAL

The goal of this study was to examine risk of reproductive tract infections (RTIs) among women in rural China, including prevalence, influence of sociodemographic characteristics, knowledge, hygienic practices, attitudes, and behaviors related to premarital and extramarital sex, and abortion.

STUDY

During 2000, a stratified cluster sample of 606 rural married women in Hainan province completed an interviewer-administered standardized questionnaire.

RESULTS

Overall, 39% of participants reported at least 1 RTI symptom in their lifetime and 20% during the past 6 months. Having had premarital sex, having sex during menstruation, belonging to an ethnic minority, being knowledgeable about RTIs, and living in a village at medium economic level were all related to having RTI symptoms.

CONCLUSION

Among married women in rural China, the prevalence of RTI symptoms was high, indicating the need for health education, particularly targeting women from ethnic minorities and resource-poor areas.

Chlamydia and gonorrhea screening in asymptomatic young women

BACKGROUND

Adolescent and young adult minority women are at high risk for chlamydia (CT) and gonorrhea (NGC) cervical infections, which are significant causes of pelvic inflammatory disease, impaired fertility, ectopic pregnancy and chronic pain. The purpose of this article is to review among young women in the United States: (1) the epidemiology of CT and NGC cervical infection and their medical complications; (2) current public health recommendations to promote asymptomatic CT and NGC screening; (3) current screening practices and challenges of implementing public health recommendations; (4) testing and cost issues; and (5) future directions in promoting asymptomatic CT and NGC screening.

METHODS

We conducted a MEDLINE search for articles published over the last two decades relating to CT and NGC screening in young women and then systematically reviewed all relevant articles.

RESULTS

The data indicate that CT and NGC infection are geographically widespread in the U.S. and asymptomatic infection is highly prevalent among economically disadvantaged young females. Public health recommendations promoting CT and NGC screening in asymptomatic young women are directed to both health care providers and clients. However, strategies to promote screening efforts have been primarily directed toward health care providers; there are no published studies on client-initiated screening strategies. Challenges of implementing public health recommendations and future directions for CT and NGC screening are discussed.

CONCLUSIONS

Young sexually active women continue to be at high risk for CT and NGC infection. The data indicate that implementation of health provider-based and client-initiated screening in private and public health care settings is a challenge. However, there is a great need to develop strategies to understand and promote client-initiated screening.

The amount and timing of parent-adolescent sexual communication as predictors of late adolescent sexual risk-taking behaviors

The present study examined the moderating role of timing of first discussion of sexual intercourse with mothers and fathers on the relationship between the amount of sexual communication and sexual risk-taking behaviors in late adolescence. Late adolescents (N = 214) completed questionnaire measures regarding the amount and timing of sexual communication with their mothers and fathers. In addition, the participants provided information about their various sexual risk-taking behaviors. In general, the results suggest that timing of first discussion of sexual intercourse contributes additional variance in several sexually risky behaviors beyond that contributed by the amount of communication with both fathers and mothers. The implications of these findings are discussed.

[Self-assessment of STD/AIDS vulnerability among women, Brazil]

OBJECTIVE

To investigate risk behaviors and self-assessment of the vulnerability to sexually transmitted diseases (STD) and acquired immunodeficiency syndrome (AIDS) among women.

METHODS

A systematic sample including 48 of 281 census tracts in the urban area of Pelotas, Brazil, was selected. There were interviewed 1,543 women, aged between 15 and 49 years, who had ever been sexually active. Risk behaviors were assessed using a confidential questionnaire that consisted of three sections: socioeconomic profile, interviewers' and self-administered questions. Data analysis was conducted using Epi-Info software, version 6.0. Statistical analysis was carried out using Kappa test and odds ratio.

RESULTS

Of all women in the sample, 64% considered impossible or almost impossible for them to acquire an STD or AIDS. The main risk behaviors were non-use of condoms in their last intercourse (72%); onset of sexual activity before age 18 years (47%); drug or alcohol use by the partner (14%) or the woman (7%) before their last intercourse; two or more partners in the last three months (7%); and anal sex in the last intercourse (3%); 44% reported two or more risk behaviors. Using a risk score of two or more points as the gold standard, sensitivity and specificity of self-assessment were 41% and 67%, respectively.

CONCLUSIONS

Self-assessment of vulnerability is not an adequate indicator of STD and AIDS vulnerability since women do not have an appropriate perception of their risks.

Mothers' influence on the timing of first sex among 14- and 15-year-olds

PURPOSE

To better understand maternal influence on the timing of first sex for adolescents.

METHODS

Using data from the National Longitudinal Study of Adolescent Health, Cox proportional hazard models were used to assess the association between maternal characteristics and the timing of first sex. Matched dyads of mothers and their adolescent children were used.

RESULTS

Of the 2,006 adolescents aged 14 and 15 years who reported to be virgins, 95 males (10.8%) and 162 females (15.8%) indicated they had initiated sex within the follow-up period, 1 year later. For males, few variables beyond the controls used in the models were predictive of timing of first sexual intercourse. For females, mother's satisfaction with her relationship with her daughter (hazard ratio =.62), mother's strong disapproval of her daughter having sex (hazard ratio =.56), and frequency of communication with the parents of her daughter's friends were associated with later sexual debut (hazard ratio =.88).

CONCLUSION

Based on the variables in the model, mothers' values and beliefs and relationship satisfaction have more influence on daughters than on sons.

Factors associated with risk behaviors for sexually transmitted disease/AIDS among urban Brazilian women: a population-based study

BACKGROUND

The proportion of women among persons with sexually transmitted disease (STD)/AIDS in Brazil is increasing rapidly, and studies are needed to understand risk behaviors.

GOAL

The goal of this study was to identify factors associated with risk behaviors for acquiring STD/AIDS among women aged 15 to 49 years in Pelotas, Brazil.

STUDY DESIGN

A representative sample of women was surveyed by means of interviewer-administered and self-administered confidential questionnaires. Of the women we sought to include, 3.5% refused and 1543 participated.

RESULTS

Risk behaviors included nonuse of condoms (72%); first intercourse before the age of 18 years (47%); use of drugs or alcohol by the partner (14%) or by the woman (7%); multiple partners (7%); and anal sex (3%). The risk score was significantly associated with being younger than age 30 years, having <5 years of schooling, being divorced or separated, and being a smoker.

CONCLUSION

Preventive strategies should prioritize efforts toward young women, those with little schooling, smokers, and those who are divorced or separated.

Concurrent sexual partnerships among women in the United States

BACKGROUND

The marked racial disparity in sexually transmitted infection (STI) rates in the United States remains inadequately explained. One important factor may be concurrent sexual partnerships (relationships that overlap in time), which can transmit STIs more rapidly through a population than does sequential monogamy.

METHODS

To determine prevalence, distribution, and correlates of U.S. women's involvement in concurrent partnerships, we analyzed sexual partnership data reported by the 10,847 women, age 15-44 years, in the 1995 National Survey of Family Growth. Overlapping sexual partnership dates were determined by computer program and visual review of the data.

RESULTS

Prevalence of concurrent partnerships since January 1991 was 12% overall. Prevalence was lowest among currently married respondents (4%) and highest among those who were formerly married (22%), never married (19%), in the lowest income stratum (17%), age 18-24 years when interviewed (23%), or who first had sexual intercourse at age 12 or 13 (35%). Prevalence was 21% among blacks, 11% among whites, 8% among Hispanics, and 6% among Asian American and Pacific Islanders. Multiple logistic analysis substantially weakened the relationship between concurrency and black race (OR = 1.2; 95% CI = 1.1-1.4).

CONCLUSIONS

Marital status in particular is strongly related to concurrency; thus, lower marriage rates among blacks and the associated higher concurrency of sexual partners may contribute to racial disparities in STI rates.

Family ecology and HIV sexual risk behaviors among African American and Puerto Rican adolescent males

This study examined the relationship between family ecology and HIV sexual risk behavior among African American and Puerto Rican adolescent males. Family, psychosocial, and HIV risk factors were assessed in 171 African American and 187 Puerto Rican adolescent males. Findings suggest that family ecology, culture, and gender role variables may differentially affect HIV sexual risk behaviors within these groups.

The relationship of unsafe sexual behavior and the characteristics of sexual partners of HIV infected and HIV uninfected adolescent females

PURPOSE

To compare characteristics of sexual relationships in HIV infected and HIV uninfected female adolescents and their association with condom use.

METHODS

HIV infected and uninfected subjects, aged 13-19 years, were enrolled in a prospective HIV study from 15 sites in 13 U.S. cities. Baseline data on demographic information, substance use, sexual behavior, partner information, and condom use were collected through direct and computer-assisted interviews from currently sexually active females. Univariate, multiple logistic regression, and repeated measures analyses were employed.

RESULTS

Data from 153 HIV infected and 90 HIV uninfected female subjects showed, on average, that current partners were 4-6 years older. In multivariate analysis, HIV infected subjects were older (OR = 1.37; 95% CI: 1.04-1.81), had more lifetime partners (OR = 2.23; 95% CI: 1.03-4.82), initiated consensual vaginal sex earlier (OR = .74; 95% CI:.58-.95), perceived partner to also be HIV infected (OR = 7.46; 95% CI: 3.2-17.4), and had less unprotected sex (OR = .27; 95% CI:.16-.45). Length of relationship was associated with more unprotected sex for both HIV infected and uninfected subjects (OR = 2.59, 95% CI: 1.27-5.27, OR = 4.13; 95% CI: 1.31-13.05, respectively). Mean partner age difference was greater among HIV infected than for HIV uninfected (OR = 1.06; 95%CI: 1.01-1.12); this greater age difference for HIV infected females was associated with less protection (OR = 1.09; 95% CI: 1.03-1.15). HIV disclosure influenced condom use: without disclosure, less condom use was reported (OR = 6.8; 95% CI: 2.29-20.24) controlling for perception that partner was also HIV infected (OR = 1.1; 95% CI: 1.02-1.21).

CONCLUSIONS

Because age differential influenced reported condom use, more research, particularly qualitative, is needed into the dynamics of these relationships. Prevention efforts must address partners, particularly older ones.

Communicating with new sex partners: college women and questions that make a difference

Despite efforts of sexuality educators, many college women are uninfluenced by information about risks of contracting a sexually transmitted disease or initiating an unintentional pregnancy. This study used an anonymous questionnaire administered to 438 never-married undergraduate women to investigate the failure of college women to ask new sex partners about sexual histories prior to sexual intercourse. Significant differences were found between the three subsample groups: those who "almost always" (AA), "sometimes" (S), or "rarely" (R) asked their sex partners about sexual histories. At first sexual intercourse, AA group women were significantly more likely to have been in a committed relationship, to have been contracepted, and to have been older; and they were less likely to have been under the influence of alcohol or other mind-altering substances. Furthermore, AA group women also reported fewer sex partners than other respondents. They also were more likely to discuss sexually related topics with their partners, to reach sexual decisions by their own thoughts, and to set personal goals.

Sexual behaviour and early coitarche in a national sample of 17 year old Swedish girls

OBJECTIVE

To evaluate sexual behaviour in 17 year old girls, using data from a national survey on adolescent sexuality.

METHOD

The study was based on two samples of 17 year olds, comprising 2% of the population born in 1973 and carried out in 1990. A school sample and a sample of school non-attenders were recruited in a two step procedure. Data were collected by anonymous self administered questionnaires. 2583 questionnaires were distributed. Response rates from students was 92%, for school non-attenders 44%. 1121 female students and 118 female school dropouts responded.

RESULTS

64% of the student girls had experienced their first intercourse; 16% were "early starters" with coitarche before age 15. STD and pregnancy were reported by 15% of early starters and pregnancy by 14%, p < 0.001 and 0.002 respectively when compared with later starters. The number of coital partners, experience of first date intercourse, and of oral and anal sex was higher in the early starters, p < 0.001. Early starters reported menarche at age 11 or earlier more often than the later starters (OR 2.30, 95% CI 1.48-3.56), as well as a perceived social age exceeding the chronological by 2 years (OR 1.94, 95% CI 1.34-2.80). Sexual abuse was reported by 20% of the early and 11% of the later starters, p = 0.002. Among school non-attenders no significant differences were found with regard to age for coitarche. A majority of 83% of the girls had experienced voluntary intercourse, and 49% were early starters. Five girls were mothers. STD was reported by 19% and induced abortion by 14%. Sexual abuse was alleged by 28%.

CONCLUSION

Coitarche before age 15 is related to early menarche and high perceived social age. High number of partners and first date intercourse make early starters at increased risk for STD and unintended pregnancy. Sexual abuse is alleged more often by early starters.