Comportements par rapport au VIH/sida et aux autres infections sexuellement transmissibles dans l'univers de la prostitution féminine

L'étude actuelle vise à décrire la situation face au VIH/sida et aux autres IST des prostituées (femmes, transgenres) exerçant dans la rue, dans les salons, dans les cabarets et autres bars en Suisse. [...] L'étude a pour objectifs d'apporter des éléments de réponse aux questions suivantes : Importance numérique, évolution et modalités d'exercice de la prostitution féminine. - "Profil" (nationalité, etc.) des prostituées selon le lieu d'exercice. - Profil des prostituées sous l'angle de la loi et autres dispositions juridiques. - Degré d'autonomie des prostituées. - Violences exercées sur les prostituées. - Comportement des prostituées face à la prévention du VIH et des autres IST. - Accès à la prévention et aux soins de santé chez les personnes qui se prostituent. - Perspectives / problèmes émergents Cette étude a fait l'objet de deux approches différentes: une revue de la littérature en Suisse et en Europe publiée depuis 2002 et des panels d'experts organisés auprès des professionnels ayant un contact régulier avec le milieu de la prostitution.

Prevención de la transmisión sexual del VIH en adolescentes

En una muestra de 119 estudiantes de cuarto de Educación Secundaria Obligatoria (ESO) y primero de Bachillerato (52,6% mujeres) se analizan los conocimientos sobre la prevención de la transmisión sexual del virus del sida, las expectativas de resultados y de autoeficacia respecto a los métodos preventivos y el tipo de prevención utilizada durante la última relación sexual. Para evitar las respuestas inducidas respecto a los comportamientos preventivos se emplea un formato de pregunta abierta. Los resultados muestran que sólo el 23,5% de los estudiantes han dado dos respuestas totalmente correctas sobre estrategias consideradas eficaces en la prevención sexual del VIH: uso del preservativo y abstinencia (por este orden). El 70,5% valoran totalmente o muy eficaz el preservativo para evitar la transmisión sexual del VIH y el 95% de los que dan la segunda respuesta juzgan totalmente eficaz la práctica de la abstinencia con la misma finalidad. En el caso del preservativo se sienten totalmente o muy capaces de usarlo el 64,3%, mientras que cuando se trata de la abstinencia sólo se perciben con esa competencia el 20%. Por lo que se refiere al uso autoinformado de métodos preventivos en la última relación, por parte de los 29 estudiantes que tuvieron actividad sexual durante el mes anterior, se observa que 21 de ellos emplearon el preservativo, dos la píldora anticonceptiva, otros dos no precisan el tipo de precaución y el resto no tomó ninguna. Tanto el reducido nivel de conocimientos sobre prevención, como la baja percepción de autoeficacia para mantenerse abstinentes, nos alertan sobre la necesidad de hacer un mayor esfuerzo de información para eliminar creencias equivocadas, como por ejemplo: sobre la pretendida eficacia protectora de tener relaciones sexuales con una pareja estable o conocida. Así mismo, conviene insistir en el uso del preservativo como anticonceptivo de elección entre los adolescentes

Cambios en las percepciones de riesgo frente al SIDA de los estudiantes universitarios durante la última década

Se revisan diversos trabajos realizados por las autoras desde 1993 sobre la percepción de riesgo frente al sida y su capacidad predictiva respecto a las conductas sexuales preventivas. Los resultados obtenidos muestran que: (1) la percepción de riesgo personal está sesgada de forma optimista y no predice ni la preocupación ni el interés por la prevención, y (2) los jóvenes universitarios no suelen detectar el elevado riesgo que supone la llamada monogamia serial (monogamia con parejas afectivas sucesivas), y se muestran favorables a mantener relaciones sexuales sin preservativo en esas circunstancias en mayor medida que con una pareja ocasional. Asimismo, estudios más recientes de las autoras ponen de manifiesto un incremento en el número de jóvenes que estarían dispuestos a mantener relaciones sexuales sin preservativo con una pareja a la que se acaba de conocer, y una disminución en los porcentajes de los que piensan en el sida al informar sobre su intención de conducta en dicha situación

Prevención de los comportamientos sexuales de riesgo en los adolescentes: SIDA, otras enfermedades de transmisión sexual y embarazos no deseados

En la actualidad, los adolescentes son uno de los grupos que por sus características conductuales, cognitivas y sociales, se encuentran en mayor riesgo frente al posible contagio con el VIH. Esta amenaza para la salud y el bienestar de los adolescentes, se ha venido a sumar a otros problemas ya existentes en este colectivo: los embarazos no deseados y las enfermedades de transmisión sexual (ETS), que también se derivan de la no utilización de precauciones en las relaciones sexuales. En este trabajo se exponen diversos factores biológicos, psicológicos (conductuales y cognitivos) y sociales que pueden facilitar, dificultar o impedir los comportamientos sexuales de prevención de los adolescentes, y se revisan y valoran algunas de las intervenciones preventivas realizadas. A partir de esta revisión se argumenta sobre la conveniencia de unificar los programas para la prevención simultánea de los tres trastornos, maximizando de esta forma los recursos disponibles

Prevalência e fatores associados á verrugas anogenitais em homens portadores de HIV/AIDS atendidos em serviço especializado

Pós-graduação em Doenças Tropicais - FMB

Nonoxynol-9 spermicide for prevention of vaginally acquired HIV and other sexually transmitted infections: systematic review and meta-analysis of randomised controlled trials including more than 5000 women

We aimed to determine the effectiveness of the vaginally administered spermicide nonoxynol-9 (N-9) among women for the prevention of HIV and other sexually transmitted infections (STIs), We did a systematic review of randomised controlled trials, Nine such trials including 5096 women, predominantly sex workers, comparing N-9 with placebo or no treatment, were included. Primary outcomes were new HIV infection, new episodes of various STIs, and genital lesions. Five trials included HIV and nine included STI outcomes, and all but one (2% of the data) contributed to the meta-analysis. Overall, relative risks of HIV infection (1.12, 95% confidence interval 0.88-1.42), gonorrhoea (0.91, 0.67-1.24), chlamyclia (0.88, 0.77-1.01), cervical infection (1.01, 0.84-1-22), trichomoniasis (0.84, 0.69-1.02), bacterial vaginosis (0.88, 0.74-1.04) and candidiasis (0.97, 0.84-1.12) were not significantly different in the N-9 and placebo or no treatment groups. Genital lesions were more common in the N-9 group (1.18, 1.02-1.36). Our review has found no statistically significant reduction in risk of HIV and STIs, and the confidence intervals indicate that any protection that may exist is likely to be very small. There is some evidence of harm through genital lesions. N-9 cannot be recommended for HIV and STI prevention.

Motivational brief intervention for the prevention of sexually transmitted infections in travelers: a randomized controlled trial.

Background: Sexually transmitted infections (STIs) are among the frequent risks encountered by travelers. Efficient interventions are needed to improve the understanding of the risks of STIs. We investigated the potential benefits of a motivational brief intervention (BI) and the provision of condoms on the engagement in unprotected casual sex.Methods: 3-arm randomized controlled trial performed among single travelers aged 18-44 years visiting a travel clinic in Switzerland. The main outcomes were the prevalence of casual unprotected sexual intercourse and their predictors.Results: 5148 eligible travelers were seen from 2006 to 2008. 1681 agreed to participate and 1115 subjects (66%) completed the study. 184/1115 (17%) had a casual sexual relationship abroad and overall 46/1115 (4.1%) had inconsistently protected sexual relations. Women (adjusted OR 2.7 [95% CI 1.4-5.6]) and travelers with a history of past STI (adjusted OR 2.8 [95% CI 1.1-7.4]) had more frequent casual sexual relationships without consistent protection. Regarding the effect of our intervention, the prevalence of subjects using condoms inconsistently was 28% (95% CI 16-40) in the motivational BI group, 24% (95% CI 10-37) in the condoms group and 24% (95% CI 14-33) in the control group (p = 0.7).Conclusion: This study showed that a motivational brief intervention and/or the provision of free condoms did not modify risky sexual behavior of young travelers. The rate of inconsistently protected sexual relationships during travel was however lower than expected

Toward global prevention of sexually transmitted infections (STIs): The need for STI vaccines.

An estimated 499 million curable sexually transmitted infections (STIs; gonorrhea, chlamydia, syphilis, and trichomoniasis) occurred globally in 2008. In addition, well over 500 million people are estimated to have a viral STI such as herpes simplex virus type 2 (HSV-2) or human papillomavirus (HPV) at any point in time. STIs result in a large global burden of sexual, reproductive, and maternal-child health consequences, including genital symptoms, pregnancy complications, cancer, infertility, and enhanced HIV transmission, as well as important psychosocial consequences and financial costs. STI control strategies based primarily on behavioral primary prevention and STI case management have had clear successes, but gains have not been universal. Current STI control is hampered or threatened by several behavioral, biological, and implementation challenges, including a large proportion of asymptomatic infections, lack of feasible diagnostic tests globally, antimicrobial resistance, repeat infections, and barriers to intervention access, availability, and scale-up. Vaccines against HPV and hepatitis B virus offer a new paradigm for STI control. Challenges to existing STI prevention efforts provide important reasons for working toward additional STI vaccines. We summarize the global epidemiology of STIs and STI-associated complications, examine challenges to existing STI prevention efforts, and discuss the need for new STI vaccines for future prevention efforts.

Mapping the Issues: HIV and Other Sexually Transmitted Infections in the United Kingdom 2005

Mapping the Issues: HIV and Other Sexually Transmitted Infections in the United Kingdom 2005

Diagnostic des maladies infectieuses: place des "point of care tests" (POCT) [Use of POCT (point of care tests) in the diagnosis of infectious diseases]

Les POCT (point of care tests) ont un grand potentiel d'utilisation en médecine infectieuse ambulatoire grâce à leur rapidité d'exécution, leur impact sur l'administration d'antibiotiques et sur le diagnostic de certaines maladies transmissibles. Certains tests sont utilisés depuis plusieurs années (détection de Streptococcus pyogenes lors d'angine, anticorps anti-VIH, antigène urinaire de S. pneumoniae, antigène de Plasmodium falciparum). De nouvelles indications concernent les infections respiratoires, les diarrhées infantiles (rotavirus, E. coli entérohémorragique) et les infections sexuellement transmissibles. Des POCT, basés sur la détection d'acides nucléiques, viennent d'être introduits (streptocoque du groupe B chez la femme enceinte avant l'accouchement et la détection du portage de staphylocoque doré résistant à la méticilline). POCT have a great potential in ambulatory infectious diseases diagnosis, due to their impact on antibiotic administration and on communicable diseases prevention. Some are in use for long (S. pyogenes antigen, HIV antibodies) or short time (S. pneumoniae antigen, P. falciparum). The additional major indications will be community-acquired lower respiratory tract infections, infectious diarrhoea in children (rotavirus, enterotoxigenic E. coli), and hopefully sexually transmitted infections. Easy to use, these tests based on antigen-antibody reaction allow a rapid diagnosis in less than one hour; the new generation of POCT relying on nucleic acid detection are just introduced in practice (detection of GBS in pregnant women, carriage of MRSA), and will be extended to many pathogens

Using STD occurence to monitor AIDS prevention : final report of the Working Group on STD Surveillance.

The overall aim of the project has been to assess the extent to which data on the frequency of occurence of STDs [Sexually transmitted diseases] might be useful in the monitoring and evaluation of AIDS prevention programmes. The objectives have been to answer the following questions: (a) Can measures of STD occurence be used as an outcome measure of AIDS/HIV preventive efforts ? In particular: -> which diseases might be useful ? -> in what ways could they be used ? (b) If measures of STD occurence can be used in this way, is existing surveillance data in Western Europe adequate for the purpose ? If not why not ? (c) What do data from existing STD surveillance systems tell us about the success or failure of AIDS prevention to date ? (d) What needs to be done in order taht STD surveillance data in the countries of Western Europe could be used for this purpose ? [Authors, p. 4]

Is Switzerland doing enough regarding the prevention of syphilis, gonorrhea and chlamydia infections ?

Sexually transmitted infections are a major problem for medicine and for public health services worldwide. More than 30 sexually transmittable pathogenic micro-organisms are known, including bacteria, viruses, fungi, protozoa and ectoparasites. According to estimates from the World Health Organisation more than 333 million of bacterial sexually transmitted infections occur worldwide per year. Sexually transmitted infections, by their nature, affect individuals, within partnerships and larger sexual networks, and in turn populations. This report focuses on three bacterial sexually transmitted infections in Switzerland that are Chlamydia trachomatis, Neisseria gonorrhea and Treponema pallidum (syphilis) in Switzerland. The prevalence of these infections has been increasing alarmingly for a decade. All three infections can be asymptomatic and their diagnosis and treatment can therefore occur too late or worse not at all, even though treatments are available. This is an important problem as untreated sexually transmitted infections may cause complications such as ascending infections, infertility, ectopic pregnancies and serious long-term neurological sequels. The consequences of these infections should not be underestimated. They constitute a significant public health burden as well as serious financial burden. The increases in chlamydia, syphilis and gonorrhea infections have also been observed in many European countries. Countries, where rising numbers of sexually transmitted infections have been observed, have reacted in different ways. Some have developed clinical guidelines or implemented screening programs, while others are still in their observational phase. The aim of this mémoire is to assess whether Switzerland is doing enough regarding the prevention of chlamydial, syphilis and gonorrheal infections. After first describing the infections, surveillance systems of sexually transmitted infections are assessed, then the epidemiological trends of these three infections are described, and finally the prevention measures implemented in Switzerland to respond to the increasing number of infections are described. The reaction of the United Kingdom to the same problem is reported for comparison. [Author, p. 7]