Developing an interactive STD-prevention program for youth: lessons from a north Indian slum

Accounting for variation in and overuse of antibiotics among humans

Worldwide, antibiotic use is increasing, but many infections against which antibiotics are applied are not even caused by bacteria. Over-the-counter and internet sales preclude physician oversight. Regional differences, between and within countries highlight many potential factors influencing antibiotic use. Taking a systems perspective that considers pharmaceutical commodity chains, we examine antibiotic overuse from the vantage point of both sides of the therapeutic relationship. We examine patterns and expectations of practitioners and patients, institutional policies and pressures, the business strategies of pharmaceutical companies and distributors, and cultural drivers of variation. Solutions to improve antibiotic stewardship include practitioners taking greater responsibility for their antibiotic prescribing, increasing the role of caregivers as diagnosticians rather than medicine providers, improving their communication to patients about antibiotic treatment consequences, lessening the economic influences on prescribing, and identifying antibiotic alternatives.

Factors influencing sexual initiation, multiple partners and condom use among male slum youth in Pune, India

This study examines the factors that influence sexual behaviours among young unmarried males living in urban slums in India, a population characterised by high vulnerability to STI and HIV infections. Data were collected from 600 unmarried male slum youth to examine the relationships between three outcomes of heterosexual behaviour (age at sexual initiation, number of sexual partners and condom use at first intercourse) and factors within the family/household social environment, peer environment and individual level during the respondents' formative years. Regression analyses found factors within the family and peer-level domains such as growing up in a two-parent household, having adequate levels of parental supervision, experiencing violence in the home and having peers who drank significantly impact the age of sexual debut and the subsequent number of lifetime partners. Condom use at first intercourse appears to be significantly influenced by age of sexual debut and type of sexual partner. These findings indicate that in low-resource urban settings, the influence of family and friends as role models can play an important role in determining the initiation of sexual behaviour among male youth and in making behaviour choices that result in favourable health outcomes.

Romance and Sex: Pre-Marital Partnership Formation among Young Women and Men, Pune District, India

Using qualitative and survey data in a rural and an urban slum setting in Pune district, India, this paper describes patterns of pre-marital romantic partnerships among young people aged 15-24, in spite of norms that discourage opposite-sex interaction before marriage. 25-40% of young men and 14-17% of young women reported opposite-sex friends. Most young people devised strategies to interact with others, largely from the same neighbourhood. There were wide gender differences with regard to making or receiving romantic proposals, having a romantic partner and experiencing hand-holding, kissing and sexual relations. For those who engaged in sexual relations, the time from the onset of the partnership to having sexual relations was short. Sex most often took place without protection or communication, and for a disturbing minority of young women only after persuasion or without consent. Among those who were unmarried, a large percentage had expected to marry their romantic partner, but for a third of young women and half of young men the relationship had been discontinued. Partnership formation often leads to physical intimacy, but intimacy should be wanted, informed and safe. Findings call for programmes that inform youth in non-threatening, non-judgmental and confidential ways, respect their sexual rights and equip them to make safe choices and negotiate wanted outcomes.

Mental health, quality of life, and nutritional status of adolescents in Dhaka, Bangladesh: comparison between an urban slum and a non-slum area

This study aims to clarify the quality of life (QOL), mental health, and nutritional status of adolescents in Dhaka city, Bangladesh by comparing non-slum areas and slums, and to find the factors associated with their mental health problems. A sample of 187 boys and 137 girls from non-slum areas, and 157 boys and 121 girls from slums, between 11-18 years old were interviewed with a questionnaire consisting of a Bangla translation of the World Health Organization Quality of Life Assessment Instrument (WHOQOL-BREF), Self Reporting Questionnaire (SRQ), Youth Self-Report (YSR) and other questions. The height and weight of the respondents were measured. All significant differences in demographic characteristics, anthropometric measures, and WHOQOL-BREF were found to reflect worse conditions in slum than in non-slum areas. Contrarily, all differences in SRQ and YSR were worse in non-slum areas for both genders, except that the "conduct problems" score for YSR was worse for slum boys. Mental states were mainly associated with school enrollment and working status. Worse physical environment and QOL were found in slums, along with gender and area specific mental health difficulties. The results suggest gender specific needs and a requirement for area sensitive countermeasures.

Understandings of reproductive tract infections in a peri-urban pueblo joven in Lima, Peru

BACKGROUND

Control programs for Reproductive Tract Infections (RTIs) typically focus on increasing awareness of risks associated with different forms of sexual contact, and pay little attention to how or why people may link RTIs to other features of their physical or social environments. This paper describes how women in a peri-urban pueblo joven located in the coastal desert surrounding Lima, Peru conceptualize the links between RTIs, sexual behaviour, personal hygiene, and the adverse environment in which they live.

METHODS

We combined qualitative interviews and a participatory voting exercise to examine social and physical environmental influences on RTIs and gynaecologic symptom interpretation.

RESULTS

Knowledge of RTIs in general was limited, although knowledge of AIDS was higher. Perceived causes of RTIs fell into three categories: sexual contact with infected persons, personal hygiene and exposure to the contaminated physical environment, with AIDS clearly related to sexual contact. The adverse environment is thought to be a major contributor to vaginal discharge, "inflamed ovaries" and urinary tract infection. The more remote parts of this periurban squatter settlement, characterized by blowing sand and dust and limited access to clean water, are thought to exhibit higher rates of RTIs as a direct result of the adverse environment found there. Stigma associated with RTIs often keeps women from seeking care or obtaining information about gynaecologic symptoms, and favours explanations that avoid mention of sexual practices.

CONCLUSION

The discrepancy between demonstrated disease risk factors and personal explanations influenced by local environmental conditions and RTI-related stigma poses a challenge for prevention programs. Effective interventions need to take local understandings of RTIs into account as they engage in dialogue with communities about prevention and treatment of RTIs.

AIDS related knowledge, attitudes, and professional preparation among social work students in India

Three-hundred and eighty-five social work students enrolled in 11 colleges in India were surveyed. Overall, the students demonstrated a moderate degree of knowledge about HIV/AIDS. However, they were generally unconcerned about the contagion. Three-fourths admitted to their lack of competence to deal with HIV+ patients. Regression analyses identified the positive effect of AIDS knowledge in combination with variables 'actual contact with AIDS patients' and 'sense of competence' on attitude toward PHWA. The paper discusses a curriculum strategy aimed at gender sensitive content and recommends behavior change as the best approach to reverse the tide of the contagion.

Premarital sexual activities among students in a university in Beijing, China

BACKGROUND

Sexually transmitted diseases are becoming a serious public health problem in China. College students are recognized as one of the age groups most affected.

GOAL

The goal was to investigate premarital sexual activities and condom use among college students in Beijing in order to collect the information necessary for research on interventions.

STUDY DESIGN

A cross-sectional survey was conducted in June 1999 among students at a university in Beijing. A self-administered, anonymous, structured questionnaire was used.

RESULTS

Among those interviewed, 41% reported premarital sexual activities: 28% had kissed partners of the opposite sex, 19% had masturbated, and 12% had engaged in sexual intercourse. Among those who had sexual intercourse, 69% had used condoms.

CONCLUSION

Today, more students are engaging in premarital sexual intercourse. Thus, it is necessary to reinforce reproductive health education among college students and provide convenient and optional services that are easily accessed.