Predictors for casual sex and/or infection among sexually transmitted disease clinic attendees in China

A Study on Knowledge, Attitude, and Practice Related to Sexually Transmitted Infections Among Students of Nonmedical Background in Manipal, India

Background

Sexually transmitted infections (STIs) are one of the major public health problems in India with adolescents being a vulnerable section of the affected population. According to the World Health Organization (WHO), one in twenty adolescents contracts an STI every year, excluding the human immunodeficiency virus (HIV) and other viral infections. It is important to assess the knowledge, attitude, and practices related to STIs among adolescents and young adults of non-medical backgrounds to educate them properly about protective and preventive measures and to allay misconceptions, if any.

Materials and Methods

This is a cross-sectional study involving 507 engineering students who were asked to fill out the predesigned anonymous questionnaire form. Results were statistically analyzed and tabulated.

Results

Of the 507 students, 375 were males and 132 were females. The mean age of the patients was 20.5 years. HIV was the most commonly identified STI (94.2%), followed by herpes genitalis (76.5%). Around 97.4% and 85.7% identified the sexual route and blood transfusion as the modes of transmission of STIs, respectively. A total of 90.9% said that the Internet was their primary source of information regarding STIs. Infertility and cancer were identified as complications by 59.5% and 25% of them, respectively. Only 23.4% were aware of the National STI Control Program. The results with respect to attitudes and practices related to STIs were variable.

Conclusion

Our study reflects that with change in time, the attitude of young adults toward sexuality is becoming very casual, but knowledge remains low. A lot of educational activities should be undertaken to educate our youth about various aspects of STIs and thus reduce the burden of the disease in the community.

Sexual Arousal Discounting: Devaluing Condom-Protected Sex as a Function of Reduced Arousal

Sexual discounting is a growing area of research aimed at identifying factors that reduce people's reported willingness to have safe sex. One commonly reported reason for condom non-use is that a condom reduces sexual arousal. However, researchers have yet to isolate the specific role of sexual arousal using a sexual discounting framework. We extended past research by measuring how sexual arousal reduced people's willingness to have condom-protected sex ("sexual arousal discounting": SAD). College students (n = 379; 67.5% females) selected partners they most wanted and least wanted to have sex with and were randomized to one of two groups. In one group, participants rated their willingness to have sex with a condom if their own arousal decreased (from 100 to 10%) from condom use. The other group completed the same task except their partner's arousal decreased from condom use instead of their own. We observed a three-way interaction between arousal levels, most versus least desirable partners, and self versus partner groups. Participants' willingness to have condom-protected sex systematically reduced as a function of sexual arousal. This was observed more with the most (vs. least) desirable partner and in the self-arousal (vs. partner-arousal) group but only when the partner was their least desirable. Men (vs. women) displayed more arousal discounting but only with the most desirable partner. Finally, higher arousal discounting was associated with lower safe-sex self-efficacy and higher reported frequency of unprotected sex in the past 3 months. This study demonstrates how reduced sexual arousal from condom use can be measured as a factor influencing sexual risk-taking.

Sustained high prevalence of viral hepatitis and sexually transmissible infections among female sex workers in China: a systematic review and meta-analysis

Background

The 1980’s economic boom has been associated with a rapid expansion of China’s sex industry over the past three decades. Consequently, the spread of sexually transmitted infections (STIs) and hepatitis infections among female sex workers (FSW) has become an important public health issue in China. This study identifies prevalence and risks of hepatitis and STIs in Chinese FSWs.

Method

Four electronic databases were searched for Chinese and English language peer-reviewed studies conducted between 01/2000-12/2011 that reported prevalence of hepatitis and STIs (excluding HIV) among Chinese FSW. Following the PRISMA guidelines, meta-analysis was used to estimate pooled prevalence and 95 % confidence intervals for each infection.

Result

Three hundred and thirty nine articles (34 in English and 305 in Chinese) investigating 603,647 FSWs in 29 Chinese provinces were included in this review. Over the period 2000–2011, the seroprevalence of active hepatitis B and hepatitis C among FSW were 10.7 % (7.3–15.5 %) and 1.0 % (0.7–1.3 %), respectively. The most prevalent STI was human papillomavirus (HPV, 27.0 % [10.1–55.1 %]), followed by herpes simplex virus-2 (HSV-2, 15.8 % [11.7–20.9 %]), chlamydia (13.7 % [12.1–15.4 %]), gonorrhoea (6.1 % [5.3–7.0 %]), syphilis (5.2 % [4.8–5.7 %]), genital warts (3.3 % [2.5–4.2 %]) and Trichomonas vaginitis (2.1 % [1.5–24.2 %]). Disease burden of both hepatitis and STI among FSW were concentrated in South Central and Southwest China. In particular, chlamydia and syphilis demonstrated a significant declining trend during the studied period (P < 0.05). Compared with the general Chinese population, FSW had significantly higher prevalence of all STIs except Trichomonas vaginitis. Further, compared to the general FSW population, HIV-positive FSW had significantly higher prevalence of syphilis, chlamydia, HSV-2 and Trichomonas vaginitis.

Conclusion

Prevalence of hepatitis and STIs remained high and mostly stable among Chinese FSW over the period of 2000–2011. Targeted STI and hepatitis surveillance and interventions should be strengthened among Chinese FSWs, especially those who are HIV-positive.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-015-1322-0) contains supplementary material, which is available to authorized users.

Heterosexual men who patronise entertainment establishments versus brothels in an Asian urban setting - which group practises riskier sexual behaviours?

BACKGROUND

Sex work has shifted from brothels to entertainment establishments (EEs) in Asia. Men who patronise EEs could act as a bridging population for human immunodeficiency virus (HIV) and sexually transmitted infection (STI) transmission through unprotected sex with the female EE workers to their spouses and regular partners. The aim of this study was to compare the prevalence and factors associated with risky sexual behaviours among the heterosexual men who patronised the EEs and brothels in Singapore.

METHODS

This was a cross-sectional survey involving 569 heterosexual men (297 recruited from brothels and 272 from EEs). A 2-stage sampling involving proportional stratified random sampling of the brothels and EEs, followed by time location sampling of the men, was conducted. For multivariable analysis, we used a mixed effects logistic model with backward elimination to account for clustering by venue and to obtain the adjusted odds ratio (aOR) for the association of various factors with consistent condom use in vaginal and oral sex respectively.

RESULTS

Men who patronised EEs were younger, more likely to be single, more highly-educated and comprised more professionals compared to the brothel group. On multivariable analysis, consistent condom use for vaginal sex decreased at the EE setting (aOR 0.64; 95 % CI: 0.42 -0.97) and with alcohol use before sex (aOR 0.67; 95 % CI: 0.46 - 0.98) and increased with perceived high risk of getting HIV/STIs from partner (aOR 2.08; 95 % CI: 1.30 - 3.32) and partner's request for condom use (aOR 5.48; 95 % CI: 1.20 - 25.11). For consistent condom use with oral sex, this decreased at the EE setting (aOR 0.64; 95 % CI: 0.39 - 0.98) and with alcohol use before sex (aOR 0.50; 95 % CI: 0.31 - 0.81) and increased with partner's request for condom use (aOR 5.19; 95 % CI: 1.38 - 19.57).

CONCLUSIONS

Men who patronised EEs practised risker sexual behaviours compared to the brothel group. Priority should be given for intervention programmes to target men who patronise EEs, which could involve the female EE workers, the EE owners as well as the managers for effective HIV/STI prevention.

Are Ureaplasma spp. a cause of nongonococcal urethritis? A systematic review and meta-analysis

Background

Nongonococcal urethritis (NGU) is the most common male reproductive tract syndrome. Ureaplasmas spp. including U. urealyticum and U. parvum, have been increasingly reported to be implicated in NGU. However, there are still many contradictions about their pathogenic role in NGU.

Aims

The goals of this study were to evaluate the association of Ureaplasmas spp. with NGU, and to compare the prevalence of Ureaplasmas spp. infection in China relative to the world average.

Methods

A systematic review and meta-analysis was conducted following standard guidelines for meta-analysis. The quality of included studies was assessed by Newcastle-Ottawa scale.

Results

A total of seven studies involving 1,507 NGU patients and 1,223 controls were eligible for meta-analysis. There was no significant difference in the Ureaplasma spp. positive rate between the NGU and control groups. However, the U. urealyticum positive rate was significantly higher in NGU patients compared to controls; the U. parvum positive rate was significantly higher in controls compared to NGU patients. Furthermore, within the NGU patient group, the positive rate of U. urealyticum was significantly higher than that of U. parvum, whereas within the control group, the opposite trend was observed. Compared to the world average, a significantly higher positive rate of Ureaplasma spp. was observed in both the NGU and control groups in China.

Conclusions

Our analysis supports that U. urealyticum, but not U. parvum, is an etiological agent in NGU. More detailed studies of these two species in China and the world could contribute to a better understanding of the epidemiology and pathogenesis, and facilitate the development of better strategies for treatment and prevention of NGU.

Understanding the meaning of short-term, yiyeqing relationships and how they are formed: implications for condom use in Liuzhou, China

Yiyeqing (YYQ) ("one night love", i.e., having sex only once with a non-commercial partner) has increased in China, concomitant with the increase in heterosexual transmission of sexually transmitted infections/human immunodeficiency virus (STI/HIV). Our study explored how participants who had experienced YYQ understood these relationships and characterized YYQ's links to sexual risk behaviors. We conducted in-depth interviews with 45 adults in Liuzhou, a city in southwest China, who had YYQ experience. We analyzed the findings using social construction to interpret the participants' understandings of YYQ. Participants reported that they tend to select YYQ partners whom they trust, which is built through introductions from social connections and within entertainment venues, resulting in the belief that their partners are free of STI/HIV and do not require protected sex. As YYQ relationships become more common, understanding the nature of these relationships is critical for developing public health messages that convey the risks associated with sex in short-term relationships and the need for condoms.

An integrated individual, community, and structural intervention to reduce HIV/STI risks among female sex workers in China

Background

We assessed the effectiveness of an integrated individual, community, and structural intervention to reduce risks of HIV and sexually transmitted infections (STIs) among female sex workers (FSWs).

Methods

The integration individual, community, and structural intervention was implemented from 2004 to 2009 in six counties of Shandong Province. Post-intervention cross-sectional surveys were conducted in six intervention counties and 10 control counties.

Results

Of 3326 female sex workers were recruited and analyzed in the post-intervention survey with 1157 from intervention sites and 2169 from control sites. No HIV positive was found in both intervention and control counties. The rate of syphilis was 0.17% for intervention sites and 1.89% for control sites (OR = 11.1, 95% CI: 2.7, 46.1). After adjusted for age, marital status, education, economic condition, recruitment venues, the rates of condom use in the last sex with clients(AOR = 2.7; 95% CI: 1.9, 3.8), with regular sex partners(AOR = 1.5; 95% CI: 1.1, 1.9) and consistent condom use in the last month with clients (AOR = 3.3; 95% CI: 2.6, 4.1) and regular sex partners (AOR = 1.7; 95% CI: 1.3, 2.3) were significantly higher in intervention sites than that in control sites. The proportion of participants correctly answered at least six out of eight HIV-related questions (83.3%) in intervention sites is significant higher than that (21.9%) in control sites (AOR = 24.7; 95% CI: 2.5, 42.7), the five indicators related to HIV-related intervention services ever received in the last year including HIV testing(AOR = 4.9; 95% CI: 2.8, 6.7), STD examination and/or treatment(AOR = 5.1; 95% CI: 4.2, 6.4), free condom(AOR = 20.3; 95% CI: 14.3, 28.9), peer education(AOR = 4.3; 95% CI: 3.5, 5.4), education materials(AOR = 19.8; 95%CI: 13.1, 29.8) were significantly higher in intervention sites than that in control sites, the participants in the intervention sites are more likely to seek medical treatment when they had any disorders (AOR = 3.2; 95% CI: 2.5, 4.2).

Conclusion

This study found that the integrated individual, community, and structural intervention showed positive impact in reducing HIV and STI risks among FSWs.

Social determinants of syphilis in South China: the effect of sibling position on syphilis and sexual risk behaviours

OBJECTIVE

This study evaluated the relationship between sibling position and sexual risk based on behavioural and syphilis infection data from sexually transmitted infection (STI) patients in South China.

DESIGN

A cross-sectional study examining sexual behaviours and syphilis infection.

SETTING

4 STI clinics in the Pearl River Delta of South China.

PARTICIPANTS

1792 Chinese men and women attending STI clinics.

PRIMARY OUTCOME MEASURES

STI history, syphilis infection defined as positive non-treponemal and treponemal tests.

RESULTS

Among all clinic patients, 824 (46.3%) were first-born, 354 (19.9%) were middle-born and 602 (33.8%) were final-born. Middle-born individuals had a higher percentage of reported STI history (44.7% compared to 34.7%, p<0.001) and syphilis infection (9.7% compared to 4.9%, p=0.01) among men (n=1163) compared to other sibling positions in bivariate analyses, but not in the final multivariate model. The relationship between sibling position and syphilis was independent of income and education level. There was no trend observed between middle-born position and female sexual risk behaviours (n=626). Higher education was significantly associated with syphilis among women and men in respective multivariate models.

CONCLUSIONS

This study suggests that middle-born men in China may have an increased sexual risk compared to other sibling positions. As Chinese family and social structures change, a more thorough understanding of how demographic factors influence sexual risk behaviours is needed.

Casual sex and concurrent sexual partnerships among young people from an Yi community with a high prevalence of HIV in China

Liangshan Prefecture in Sichuan province, China, has a high prevalence of HIV infection, which is reflective of a change in the mode of transmission from injection drug use (IDU) to heterosexual intercourse. However, few studies focus on HIV-related heterosexual risk behaviours among the majority Yi population. The objectives of this study were to explore the characteristics of an egocentric sexual network and estimate the prevalence of casual sexual behaviour. Yi villagers (n=108), aged 15-35 years, who reported having had sex within the previous year were interviewed as to their sexual behaviours and networks. In-depth interviews and focus group discussions provided supplementary information on sexual norms. Logistic regression analysis was used to calculate unadjusted odds ratios (ORs) and 95% confidence intervals (CIs). Most of the respondents reported having had casual sex at some time in their life, and 66.7% reported multiple sexual partnerships. Only 21.3% reported ever having used a condom. During the study year, a total of 137 partners were involved in 153 sexual partnerships. Among the reported sexual partnerships, 67.3% originated from a casual sexual relationship. For network members in components of size ≥ 3, 56.9% were involved in concurrent sexual partnerships. Having never been married (OR: 2.11; 95% CI: 1.03-4.33) and younger age (OR: 0.89; 95% CI: 0.83-0.95) were both associated with being in a component of size ≥ 3. Size (OR: 2.99; 95% CI: 1.17-7.66), pair (OR: 0.54; 95% CI: 0.39-0.74), the number of weak components of the egocentric sexual network (OR: 30.04; 95% CI: 6.47-139.46) and gender (OR: 0.19; 95% CI: 0.06-0.67) were all associated with being in concurrent sexual partnerships. HIV-related interventions for the Yi ethnic minority in Sichuan province must therefore address concurrent sexual partnerships and promote condom use.

HIV/STD pattern and its associated risk factors among male STD clinic attendees in China: a foci for HIV intervention

BACKGROUND

Previous studies suggested a high prevalence of STDs including HIV among female sex workers and men who have sex with men in China, but little was known about the prevalence in male patients attending public STD clinics. The aim of this study was to investigate STD patterns and HIV prevalence among male STD clinic attendees in different areas in China and the associated risk factors. The feasibility of Provider-initiated HIV testing and counseling (PITC) was evaluated as well.

METHODS

A cross-sectional study was conducted at 46 public STD clinics in 4 provinces in China. Between July 2009 and September 2009, a total of 3243 eligible subjects were invited to participate in an interview with a structured-questionnaire for collecting socio-demographic characteristics and sexual behavioral information. They also were asked to provide venous blood samples for serological determinations of HIV and syphilis infection, and first void urine specimens for detecting Chlamydia trachomatis and Neisseria gonorrhoeae infections,

RESULTS

Out of the 3243 eligible patients, 2951(91%) men agreed to take part in the HIV and syphilis testing. The overall prevalence rate of HIV infection was 0.7% while the rates of syphilis, N. gonorrhoeae, C. trachomatis infections were 10.7%, 4.3% and 6.9%, respectively, with the highest syphilis and N. gonorrhoeae rates in Jiangsu Province. Patients from Guangxi province, homosexual/bisexual practices and intravenous drug use were significantly associated with HIV infection in multivariate logistic regression analyses. Provider-initiated HIV testing and counseling (PITC) was well accepted by attendees, with 91% of eligible attendees agreeing to undergo HIV testing and counseling. All HIV positive patients were properly managed accordingly.

CONCLUSIONS

A modest prevalence of HIV infection and substantial prevalence of other STD infections were found among male patients attending public STD clinics in China. The findings further support the introduction of HIV and syphilis PITC strategy into this important setting.

Population-based study of asymptomatic infection with Chlamydia trachomatis among female and male students

There are few epidemiological studies of asymptomatic chlamydial infection among students in non-medical settings with minimal bias and improved accuracy; thus, useful data from screening among students are limited. We aimed to obtain accurate epidemiological information about asymptomatic chlamydial infection among students in non-medical settings. A population-based cross-sectional survey of 10,440 >or=18-year-old asymptomatic students who volunteered for a urine screening test for chlamydia was conducted. The prevalences of asymptomatic infection were 9.5% for women and 6.7% for men. Multivariate analysis revealed the risk factors to be a lifetime history of >or=4 sexual partners for women (odds ratio [OR] 3.17) and inconsistent condom use for men (OR 4.18). For both sexes, younger age at first intercourse was associated with a higher rate of inconsistent condom use. This study produced accurate epidemiological information on asymptomatic chlamydial infection. These results may contribute to the establishment of preventive countermeasures against such infection.