Gender differences in the risk of HIV infection among persons reporting abstinence, monogamy, and multiple sexual partners in northern Tanzania.

BACKGROUND: Monogamy, together with abstinence, partner reduction, and condom use, is widely advocated as a key behavioral strategy to prevent HIV infection in sub-Saharan Africa. We examined the association between the number of sexual partners and the risk of HIV seropositivity among men and women presenting for HIV voluntary counseling and testing (VCT) in northern Tanzania. METHODOLOGY/ PRINCIPAL FINDINGS: Clients presenting for HIV VCT at a community-based AIDS service organization in Moshi, Tanzania were surveyed between November 2003 and December 2007. Data on sociodemographic characteristics, reasons for testing, sexual behaviors, and symptoms were collected. Men and women were categorized by number of lifetime sexual partners, and rates of seropositivity were reported by category. Factors associated with HIV seropositivity among monogamous males and females were identified by a multivariate logistic regression model. Of 6,549 clients, 3,607 (55%) were female, and the median age was 30 years (IQR 24-40). 939 (25%) females and 293 (10%) males (p<0.0001) were HIV seropositive. Among 1,244 (34%) monogamous females and 423 (14%) monogamous males, the risk of HIV infection was 19% and 4%, respectively (p<0.0001). The risk increased monotonically with additional partners up to 45% (p<0.001) and 15% (p<0.001) for women and men, respectively with 5 or more partners. In multivariate analysis, HIV seropositivity among monogamous women was most strongly associated with age (p<0.0001), lower education (p<0.004), and reporting a partner with other partners (p = 0.015). Only age was a significant risk factor for monogamous men (p = 0.0004). INTERPRETATION: Among women presenting for VCT, the number of partners is strongly associated with rates of seropositivity; however, even women reporting lifetime monogamy have a high risk for HIV infection. Partner reduction should be coupled with efforts to place tools in the hands of sexually active women to reduce their risk of contracting HIV.

Facts and Fictions: Feminist Literary Criticism and Cultural Critique, 1968-2012

"Facts and Fictions: Feminist Literary Criticism and Cultural Critique, 1968-2012" is a critical history of the unfolding of feminist literary study in the US academy. It contributes to current scholarly efforts to revisit the 1970s by reconsidering often-repeated narratives about the critical naivety of feminist literary criticism in its initial articulation. As the story now goes, many of the most prominent feminist thinkers of the period engaged in unsophisticated literary analysis by conflating lived social reality with textual representation when they read works of literature as documentary evidence of real life. As a result, the work of these "bad critics," particularly Kate Millett and Andrea Dworkin, has not been fully accounted for in literary critical terms.

This dissertation returns to Dworkin and Millett's work to argue for a different history of feminist literary criticism. Rather than dismiss their work for its conflation of fact and fiction, I pay attention to the complexity at the heart of it, yielding a new perspective on the history and persistence of the struggle to use literary texts for feminist political ends. Dworkin and Millett established the centrality of reality and representation to the feminist canon debates of "the long 1970s," the sex wars of the 1980s, and the more recent feminist turn to memoir. I read these productive periods in feminist literary criticism from 1968 to 2012 through their varied commitment to literary works.

Chapter One begins with Millett, who de-aestheticized male-authored texts to treat patriarchal literature in relation to culture and ideology. Her mode of literary interpretation was so far afield from the established methods of New Criticism that she was not understood as a literary critic. She was repudiated in the feminist literary criticism that followed her and sought sympathetic methods for reading women's writing. In that decade, the subject of Chapter Two, feminist literary critics began to judge texts on the basis of their ability to accurately depict the reality of women's experiences.

Their vision of the relationship between life and fiction shaped arguments about pornography during the sex wars of the 1980s, the subject of Chapter Three. In this context, Dworkin was feminism's "bad critic." I focus on the literary critical elements of Dworkin's theories of pornographic representation and align her with Millett as a miscategorized literary critic. In the decades following the sex wars, many of the key feminist literary critics of the founding generation (including Dworkin, Jane Gallop, Carolyn Heilbrun, and Millett) wrote memoirs that recounted, largely in experiential terms, the history this dissertation examines. Chapter Four considers the story these memoirists told about the rise and fall of feminist literary criticism. I close with an epilogue on the place of literature in a feminist critical enterprise that has shifted toward privileging theory.

Gender and racial/ethnic differences in addiction severity, HIV risk, and quality of life among adults in opioid detoxification: results from the National Drug Abuse Treatment Clinical Trials Network.

PURPOSE: Detoxification often serves as an initial contact for treatment and represents an opportunity for engaging patients in aftercare to prevent relapse. However, there is limited information concerning clinical profiles of individuals seeking detoxification, and the opportunity to engage patients in detoxification for aftercare often is missed. This study examined clinical profiles of a geographically diverse sample of opioid-dependent adults in detoxification to discern the treatment needs of a growing number of women and whites with opioid addiction and to inform interventions aimed at improving use of aftercare or rehabilitation. METHODS: The sample included 343 opioid-dependent patients enrolled in two national multi-site studies of the National Drug Abuse Treatment Clinical Trials Network (CTN001-002). Patients were recruited from 12 addiction treatment programs across the nation. Gender and racial/ethnic differences in addiction severity, human immunodeficiency virus (HIV) risk, and quality of life were examined. RESULTS: Women and whites were more likely than men and African Americans to have greater psychiatric and family/social relationship problems and report poorer health-related quality of life and functioning. Whites and Hispanics exhibited higher levels of total HIV risk scores and risky injection drug use scores than African Americans, and Hispanics showed a higher level of unprotected sexual behaviors than whites. African Americans were more likely than whites to use heroin and cocaine and to have more severe alcohol and employment problems. CONCLUSIONS: Women and whites show more psychopathology than men and African Americans. These results highlight the need to monitor an increased trend of opioid addiction among women and whites and to develop effective combined psychosocial and pharmacologic treatments to meet the diverse needs of the expanding opioid-abusing population. Elevated levels of HIV risk behaviors among Hispanics and whites also warrant more research to delineate mechanisms and to reduce their risky behaviors.