Sexual behavior and exposure to HIV infection: estimates from a general-population risk index

Scaling sexual behavior or "sexual risk propensity" among men at risk for HIV in Kisumu, Kenya

We present a scale to measure sexual risk behavior or "sexual risk propensity" to evaluate risk compensation among men engaged in a randomized clinical trial of male circumcision. This statistical approach can be used to represent each respondent's level of sexual risk behavior as the sum of his responses on multiple dichotomous and rating scale (i.e. ordinal) items. This summary "score" can be used to summarize information on many sexual behaviors or to evaluate changes in sexual behavior with respect to an intervention. Our 18 item scale demonstrated very good reliability (Cronbach's alpha of 0.87) and produced a logical, unidimensional continuum to represent sexual risk behavior. We found no evidence of differential item function at different time points (except for reporting a concurrent partners when comparing 6 and 12 month follow-up visits) or with respect to the language with which the instrument was administered. Further, we established criterion validity by demonstrating a statistically significant association between the risk scale and the acquisition of incident sexually transmitted infections (STIs) at the 6 month follow-up and HIV at the 12 month follow-up visits. This method has broad applicability to evaluate sexual risk behavior in the context of other HIV and STI prevention interventions (e.g. microbicide or vaccine trials), or in response to treatment provision (e.g., anti-retroviral therapy).

HIV and AIDS risk behaviors among female jail detainees: implications for public health policy

OBJECTIVES

We examined the sexual and injection drug use HIV and AIDS risk behaviors of female jail detainees.

METHODS

The sample (n = 948) was stratified by charge type (felony vs misdemeanor) and race/ethnicity (African American, non-Hispanic White, Hispanic, other).

RESULTS

Non-Hispanic White women, women arrested for less serious charges, women who had prior arrests, women arrested on drug charges, and women with severe mental disorders were at especially high risk for sexual and injection drug transmission of HIV and AIDS.

CONCLUSIONS

Many women at risk for HIV and AIDS--women who use drugs, women who trade sex for money or drugs, homeless women, and women with mental disorders--eventually will cycle through jail. Because most jail detainees return to their communities within days, providing HIV and AIDS education in jail must become a public health priority.

Direct expenditures for the treatment of allergic rhinoconjunctivitis in 1996, including the contributions of related airway illnesses

BACKGROUND

Previous estimates of the national economic burden of allergic rhinoconjunctivitis (AR/AC) have relied on data analyses in which AR/AC was the primary International Classification of Diseases-ninth revision-Clinical Modification (ICD-9-CM)-coded diagnosis. These studies ignore the costs when AR/AC was a secondary diagnosis to other disorders such as asthma and sinusitis.

OBJECTIVE

We sought to determine the national direct cost of illness for AR/AC.

METHODS

An expert panel used the Delphi technique to estimate the proportion of visits coded by other primary ICD-9-CM diagnoses in which AR/AC was a significant secondary comorbid condition. The costs of this proportion were deemed to be "attributable" to AR/AC and were added to the costs when allergic rhinitis and allergic conjunctivitis were the primary diagnoses.

RESULTS

The cost when AR/AC was the primary diagnosis was $1.9 billion (in 1996 dollars). The cost when AR/AC was a secondary diagnosis was estimated at $4.0 billion, giving an estimate of $5.9 billion for the overall direct medical expenditures attributable to AR/AC. Outpatient services (63%, $3.7 billion), medications (25%, $1.5 billion), and inpatient services (12%, $0.7 billion) accounted for the expenditures. Children 12 years and younger accounted for $2.3 billion (38.0%).

CONCLUSION

Upper airway allergy is an expensive disease process because of its readily apparent manifestations as AR/AC and its contribution to other airway disorders.

Health risk taking and human immunodeficiency virus risk in collegiate female athletes

Risky health behaviors of female intercollegiate varsity athletes and their nonathlete peers were compared. Five hundred seventy-one female university students (109 athletes and 462 nonathlete peers) at two midwestern universities completed a self-administered, anonymous questionnaire during team meetings or class sessions. Each athlete was matched with two nonathlete controls of similar age, ethnicity, and class year to test for dichotomous outcome variables. A human immunodeficiency virus (HIV) risk scale was developed to identify factors associated with increased HIV risk for all of the female participants. Measures of alcohol and other drug use were associated with HIV risk. The athletes were found to engage in significantly fewer risk-taking behaviors than the nonathletes and to be at less risk for HIV. High levels of risk behaviors generally indicated the need for increased efforts to change risky behaviors in all college women.

A risk index for sexually transmitted diseases

BACKGROUND AND OBJECTIVES

The basic reproductive ratio, RO, is a useful measure to compare the potential for spread of sexually transmitted diseases (STDs) between populations. But RO is a population risk measure; and individual risk index is needed.

STUDY DESIGN

An individual, STD-specific potential risk index was developed based on the basic reproductive ratio formula. The index was estimated for 10,643 subjects aged 18 to 60 years taking part in surveys of sexual behavior conducted in 1987 and 1992, using human immunodeficiency virus (HIV) and chlamydial infections as examples.

RESULTS

Of the total population, 2.8% were at potential risk for HIV infection, and 5.2% for chlamydial infection. The two groups overlapped only partially. There where more than 15 times as many at potential risk among single subjects as among married/cohabiting subjects for both infections.

CONCLUSIONS

The risk index developed measures STD-specific potential risk. It can be used to estimate the size of risk groups in populations, and the association between risk and sociodemographic and behavioral variables. Further research is needed to include the effects of partner mixing in the index.

Fractures attributable to osteoporosis: report from the National Osteoporosis Foundation

To assess the cost-effectiveness of interventions to prevent osteoporosis, it is necessary to estimate total health care expenditures for the treatment of osteoporotic fractures. Resources utilized for the treatment of many diseases can be estimated from secondary databases using relevant diagnosis codes, but such codes do not indicate which fractures are osteoporotic in nature. Therefore, a panel of experts was convened to make judgments about the probabilities that fractures of different types might be related to osteoporosis according to patient age, gender, and race. A three-round Delphi process was applied to estimate the proportion of fractures related to osteoporosis (i.e., the osteoporosis attribution probabilities) in 72 categories comprised of four specific fracture types (hip, spine, forearm, all other sites combined) stratified by three age groups (45-64 years, 65-84 years, 85 years and older), three racial groups (white, black, all others), and both genders (female, male). It was estimated that at least 90% of all hip and spine fractures among elderly white women should be attributed to osteoporosis. Much smaller proportions of the other fractures were attributed to osteoporosis. Regardless of fracture type, attribution probabilities were less for men than women and generally less for non-whites than whites. These probabilities will be used to estimate the total direct medical costs associated with osteoporosis-related fractures in the United States.

Changes in sexual behaviour of patients attending an HIV testing centre: a prospective study 1988-1994

OBJECTIVE

To evaluate the sexual behaviour changes in patients attending HIV testing during the period July 1988 to June 1994.

DESIGN

In a prospective study, 6824 face-to-face interviews were carried out before the HIV test was performed. The frequency of condom use and the number of sexual partners during the 6 previous months were recorded annually from July to June. The data were analysed according to gender, age class and sexual orientation.

SETTING

Strasbourg, Bas-Rhin, France.

SUBJECTS

Patients attending the HIV testing centre of Strasbourg.

RESULTS

There was a striking increase in the number of attenders of this centre from 358 patients in 1988/89 to 2421 in 1993/94. We observed a significant decrease of homosexuals having more than five partners (p < 0.05) whereas multipartner sex remained unchanged in heterosexuals. There was no change in the proportion of patients having only one partner, except a slight raise in patients under 20 years. All groups showed a very significant increase in condom use, which was especially marked in young heterosexuals aged under 30 years. Nevertheless, condom use remained higher in homosexuals than in heterosexuals in 1993/94. In addition, there was a striking fall of past sexually transmitted disease in heterosexual patients under 20 years during the study period, and a fall in the HIV positivity rate from 1.96% to 0.42%.

CONCLUSIONS

A major increase was noted in condom use in all groups and a reduction of multipartner sex in some patients. These data are encouraging in the younger patients, but prevention efforts should also be concentrated on middle aged patients who did not show major sexual changes, although having important risk factors for HIV infection.

Misunderstanding of 'safer sex' by heterosexually active adults

To assess the understanding of safer sex among heterosexual adults, people enrolled in human immunodeficiency virus (HIV) education trials at a sexually transmitted disease (STD) clinic and a university student health service were surveyed concerning sexual behavior with their latest reported partner. Of 646 sexually active persons enrolled in the trials, 233 (36 percent) reported having had safer sex with their latest partner; 124 of them (53 percent) also reported having vaginal or anal intercourse without a condom during that sexual encounter. Among the 124 who reported safer sex despite having intercourse without a condom, only 23 percent reported asking partners about their HIV status, 46 percent had asked about intravenous drug use, and 47 percent had asked about the number of prior sexual partners. For 34 percent of those surveyed, the length of the sexual relationship with their latest partner was 1 month or less, and 18 percent estimated that this partner had had 11 or more prior sexual partners. STD clinic participants characterized intercourse without a condom as safer sex more often than student health service enrollees (76 percent versus 39 percent, P < 0.001). The concept of safer sex is often misunderstood by persons engaging in behavior at risk for HIV transmission, and the level of misunderstanding differs among samples. Interventions to reduce transmission of HIV must confront misconceptions about the risk of sexual intercourse without condoms and include specific instructions understood by the targeted group.