Sexual risk behaviors and HIV risk among Americans aged 50 years or older: a review.

Although HIV-related sexual risk behaviors have been studied extensively in adolescents and young adults, there is limited information about these behaviors among older Americans, which make up a growing segment of the US population and an understudied population. This review of the literature dealing with sexual behaviors that increase the risk of becoming HIV-infected found a low prevalence of condom use among older adults, even when not in a long-term relationship with a single partner. A seminal study by Schick et al published in 2010 reported that the prevalence of condom use at last intercourse was highest among those aged 50-59 years (24.3%; 95% confidence interval, 15.6-35.8) and declined with age, with a 17.1% prevalence among those aged 60-69 years (17.1%; 95% confidence interval, 7.3-34.2). Studies have shown that older Americans may underestimate their risk of becoming HIV-infected. Substance use also increases the risk for sexual risk behaviors, and studies have indicated that the prevalence of substance use among older adults has increased in the past decade. As is the case with younger adults, the prevalence of HIV infections is elevated among ethnic minorities, drug users (eg, injection drug users), and men who have sex with men. When infected, older adults are likely to be diagnosed with HIV-related medical disorders later in the course of illness compared with their younger counterparts. Physicians are less likely to discuss sexual risk behaviors with older adults and to test them for HIV compared with younger adults. Thus, it is important to educate clinicians about sexual risk behaviors in the older age group and to design preventive interventions specifically designed for older adults.

The Influence of Gene Environment Interaction on the Risk of Cognitive Impairment: Reducing Sexual Risk Behaviors and Alcohol Use in HIV-infected Adults

Memory deficits and executive dysfunction are highly prevalent among HIV-infected adults. These conditions can affect their quality of life, antiretroviral adherence, and HIV risk behaviors. Several factors have been suggested including the role of genetics in relation to HIV disease progression. This dissertation aimed to determine whether genetic differences in HIV-infected individuals were correlated with impaired memory, cognitive flexibility and executive function and whether cognitive decline moderated alcohol use and sexual transmission risk behaviors among HIV-infected alcohol abusers participating in an NIH-funded clinical trial comparing the efficacy of the adapted Holistic Health Recovery Program (HHRP-A) intervention to a Health Promotion Control (HPC) condition in reducing risk behaviors. A total of 267 individuals were genotyped for polymorphisms in the dopamine and serotonin gene systems. Results yielded significant associations for TPH2, GALM, DRD2 and DRD4 genetic variants with impaired executive function, cognitive flexibility and memory. SNPs TPH2 rs4570625 and DRD2 rs6277 showed a risk association with executive function (odds ratio = 2.5, p = .02; 3.6, p = .001). GALM rs6741892 was associated with impaired memory (odds ratio = 1.9, p = .006). At the six-month follow-up, HHRP-A participants were less likely to report trading sex for food, drugs and money (20.0%) and unprotected insertive or receptive oral (11.6%) or vaginal and/or anal sex (3.2%) than HPC participants (49.4%, p

Risk-taking behaviours in adolescent boys and girls : sexuality and dietary health

This study examined adolescents' reported sexual and dietary health-risk behaviours and perceptions. Specifically, this study analyzed the data of 600 students (300 male~ 300 female) in grades 9, I 1, and OAC (mean, standard deviation). The mean age of the students in the sample is 16 with a standard deviation of 1.6. The study was a secondary analysis ofthe first-year data of a 3-year longitudinal study conducted by Youth Lifestyle Choices-Community University Research Alliance (YLC-CURA) on adolescents. To explore sexuality and dietary health, this study purposefully selected sections of the survey that represented sex and dieting behaviours of adolescents. Separate gender and age data analyses revealed different patterns among the variables. Specifically., findings revealed that adolescents who engaged in recent sexual activities were more likely to have a relatively more positive body image perception and were relatively more likely to engage in disordered eating. Across both genders and 3 age levels, adolescents reported that despite their unhealthy dietary habits they felt that dieting was not a high-risk behaviour. Results were discussed in terms of educational implication for sexual health programs.

A Study on Health Behaviours and Young People

Numerous reports have documented the health status of young people, concluding that the main threats to their health are predominantly the health risk behaviours and choices they make. Focussing on four of these, alcohol consumption, tobacco smoking, illicit drug use and sexual activity, this study seeks to assess their levels among a group of young people in Galway City with the aim of helping with the development of Health Education in these areas. In order to develop appropriate interventions, it is first of all necessary that accurate information on the extent of the problem, if any, be available. In 1989, studies on risk taking were carried out in the Muirhouse and Easterhouse areas of Glasgow and Edinburgh in Scotland. These areas were seen as underprivileged and had high and low rates of HIV infection respectively. In 1993, a similar study was carried out in the Westside area of Galway, an area which is also seen as under-privileged with high rates of unemployment. In 1996, a follow-up to the 1993 survey was carried out. This study also attempted to determine if there was a relationship between the behaviours reported and socio-economic class. This study is a follow-up to the previous two, with the addition that it attempts to investigate whether any relationship exists between the provision of health education in schools and subsequent health behaviour patternsThis resource was contributed by The National Documentation Centre on Drug Use.

Self-reported risk perception, mood and risk behaviour across the human menstrual cycle

Normally ovulating women exhibit a decline in risk behaviours that may lead to sexual assault during the fertile phase of the menstrual cycle, whereas women using the Pill do not. The current study tests two explanatory models: the mood and fertility models. Self-reported risk and non-risk behaviours, mood, and risk perception in sexual assault and physical risk domains were assessed by testing fiftyone women at menstruation and during their fertile period. Based on the decline in risk behaviours shown in past research, the fertility model predicts that normally ovulating women will display greater risk perception during the fertile phase of their cycle. The mood model predicts that at menstruation, when negative mood is highest, risk perception will be increased and risk behaviours correspondingly reduced. Risk behaviours did not vary over the cycle or between groups. Overall, results support the mood model. Negative mood was greater at menstruation and positive mood during the fertile period for both groups, rational risk perception was correspondingly greater at menstruation. The fertility model was not supported as risk perception ratings did not vary in the expected direction and ratings were not specific to the sexual assault domain.

Maltreatment, psychiatric symptoms and human immunodeficiency virus/sexual transmitted infection risk behavior among youth with alcohol and other drug use problems: A person-centered analysis

Multi-problem youth undergoing treatment for substance use problems are at high behavioral risk for exposure to sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). Specific risk factors include childhood adversities such as maltreatment experiences and subsequent forms of psychopathology. The current study used a person-centered analytical approach to examine how childhood maltreatment experiences were related to patterns of psychiatric symptoms and HIV/STI risk behaviors in a sample of adolescents (N = 408) receiving treatment services. Data were collected in face-to-face interviews at two community-based facilities. Descriptive statistics and Latent Profile Analysis (LPA) were used to (a) classify adolescents into groups based on past year psychiatric symptoms, and (b) examine relations between class membership and forms of childhood maltreatment experiences, as well as past year sexual risk behavior (SRB). ^ LPA results indicated significant heterogeneity in psychiatric symptoms among the participants. The three classes generated via the optimal LPA solution included: (a) a low psychiatric symptoms class, (b) a high alcohol symptoms class and (c) a high internalizing symptoms class. Class membership was associated significantly with adolescents’ self-reported scores for childhood sexual abuse and emotional neglect. ANOVAs documented significant differences in mean scores for multiple indices of SRB indices by class membership, demonstrating differential risk for HIV/STI exposure across classes. The two classes characterized by elevated psychiatric symptom profiles and more severe maltreatment histories were at increased behavioral risk for HIV/STI exposure, compared to the low psychiatric symptoms class. The high internalizing symptoms class reported the highest scores for most of the indices of SRB assessed. The heterogeneity of psychiatric symptom patterns documented in the current study has important implications for HIV/STI prevention programs implemented with multi-problem youth. The results highlight complex relations between childhood maltreatment experiences, psychopathology and multiple forms of health risk behavior among adolescents. The results underscore the importance of further integration between substance abuse treatment and HIV/STI risk reduction efforts to improve morbidity and mortality among vulnerable youth. ^

Maltreatment, Psychiatric Symptoms and Human Immunodeficiency Virus/Sexual Transmitted Infection Risk Behavior Among Youth with Alcohol and Other Drug Use Problems: A Person-Centered Analysis

Multi-problem youth undergoing treatment for substance use problems are at high behavioral risk for exposure to sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). Specific risk factors include childhood adversities such as maltreatment experiences and subsequent forms of psychopathology. The current study used a person-centered analytical approach to examine how childhood maltreatment experiences were related to patterns of psychiatric symptoms and HIV/STI risk behaviors in a sample of adolescents (N = 408) receiving treatment services. Data were collected in face-to-face interviews at two community-based facilities. Descriptive statistics and Latent Profile Analysis (LPA) were used to (a) classify adolescents into groups based on past year psychiatric symptoms, and (b) examine relations between class membership and forms of childhood maltreatment experiences, as well as past year sexual risk behavior (SRB). LPA results indicated significant heterogeneity in psychiatric symptoms among the participants. The three classes generated via the optimal LPA solution included: (a) a low psychiatric symptoms class, (b) a high alcohol symptoms class and (c) a high internalizing symptoms class. Class membership was associated significantly with adolescents’ self-reported scores for childhood sexual abuse and emotional neglect. ANOVAs documented significant differences in mean scores for multiple indices of SRB indices by class membership, demonstrating differential risk for HIV/STI exposure across classes. The two classes characterized by elevated psychiatric symptom profiles and more severe maltreatment histories were at increased behavioral risk for HIV/STI exposure, compared to the low psychiatric symptoms class. The high internalizing symptoms class reported the highest scores for most of the indices of SRB assessed. The heterogeneity of psychiatric symptom patterns documented in the current study has important implications for HIV/STI prevention programs implemented with multi-problem youth. The results highlight complex relations between childhood maltreatment experiences, psychopathology and multiple forms of health risk behavior among adolescents. The results underscore the importance of further integration between substance abuse treatment and HIV/STI risk reduction efforts to improve morbidity and mortality among vulnerable youth.

Neural Mechanisms of Young Adult Sexual Decision-Making and Risk Behavior

Sexual risk behavior among young adults is a serious public health concern; 50% will contract a sexually transmitted infection (STI) before the age of 25. The current study collected self-report personality and sexual history data, as well as neuroimaging, experimental behavioral (e.g., real-time hypothetical sexual decision making data), and self-report sexual arousal data from 120 heterosexual young adults ages 18-26. In addition, longitudinal changes in self-reported sexual behavior were collected from a subset (n = 70) of the participants. The primary aims of the study were (1) to predict differences in self-report sexual behavior and hypothetical sexual decision-making (in response to sexually explicit audio-visual cues) as a function of ventral striatum (VS) and amygdala activity, (2) test whether the association between sexual behavior/decision-making and brain function is moderated by gender, self-reported sexual arousal, and/or trait-level personality factors (i.e., self-control, impulsivity, and sensation seeking) and (3) to examine how the main effects of neural function and interaction effects predict sexual risk behavior over time. Our hypotheses were mostly supported across the sexual behavior and decision-making outcome variables, such that neural risk phenotypes (heightened reward-related ventral striatum activity coupled with decreased threat-related amygdala activity) were associated with greater lifetime sexual partners at baseline measured and over time (longitudinal analyses). Impulsivity moderated the relationship between neural function and self-reported number of sexual partners at baseline and follow up measures, as well as experimental condom use decision-making. Sexual arousal and sensation seeking moderated the relationship between neural function and baseline and follow up self-reports of number of sexual partners. Finally, unique gender differences were observed in the relationship between threat and reward-related neural reactivity and self-reported sexual risk behavior. The results of this study provide initial evidence for the potential role for neurobiological approaches to understanding sexual decision-making and risk behavior. With continued research, establishing biomarkers for sexual risk behavior could help inform the development of novel and more effective individually tailored sexual health prevention and intervention efforts.

Attachment style as a predictor of sexual attitudes and behavior in late adolescence

This research applied attachment theory to the study of sexual attitudes and behaviors in a sample of late adolescents. Four hundred and seventy heterosexual undergraduate students completed questionnaires assessing attachment (discomfort with closeness; anxiety over relationships), relationship history, communication about sex, sexual self-efficacy and locus of control, and attitudes to condoms. Eight weeks later, participants reported on sexual behaviors occurring during the eight-week interval, and perceived risk of these activities. Both discomfort with closeness and anxiety over relationships were associated with external locus of control for sexual outcomes, and with use of drugs before sexual contact. Anxiety over relationships was linked to unsafe sex and to negative attitudes to condoms, but discomfort with closeness was associated with a more cautious approach to sexual risk-taking. Some results were qualified by gender differences, and by differences between the full sample and those who were sexually active. The findings are discussed in terms of attachment style and its links with communication and affect regulation.

Playing With Fire: Decrease in Safe-Sex Attitudes Among Men Who Have Sex With Men in a Portuguese STI Clinic

Background: Sexually transmitted infections (STIs) present a major public health concern and a global cause of illness in both industrialized and developing countries. Portugal is no exception, with an increasing incidence of STIs, and one of the highest prevalences of HIV in Europe. Reduced risk perceptions among men who have sex with men (MSM) and a consequent high-risk sexual behaviour have been increasingly reported throughout the world. Objectives: To characterize the population of MSM attending a STI clinic in Lisbon, and to assess practice of condom use among these patients. Methods: Records of all MSM patients who attended the STI clinic from 2008 to 2011 were reviewed to study demographic characteristics, sexual behaviours, and leading diagnoses in this population. Results: Of a total of 389 patients, 108 MSM were identified (27.8%), mostly Portuguese men with high school or above education, aged 17 to 61 years (medium age of 32.4 years). More than half of the patients (52.8%) reported more than one sexual partner in the past 6 months (19.4% more than 5 partners), and only a third consistently used condom. A history of sex with sex workers was mentioned in 9.2%. The most prevalent diagnoses were syphilis (45.6%) and condylomata acuminata (38.9%). The prevalence of HIV infection in this subgroup of patients was significantly higher than in the rest of the population (47.2% vs. 14.9%). Inconsistent condom use increased over the years (36.4% in 2008, 66.7% in 2011), and these patients revealed a greater number of sexual partners than condom users (60.4% vs. 50%). However, 38.9% of condom users presented with early syphilis, suggesting inadequate use of this barrier method. Among HIV patients, almost half of them (49%) had sex with more than one partner in the previous six months, and 47.1% did not use the condom during all sexual practices. Of these, 45.8% were not on antiretroviral therapy. Conclusions: High-risk sexual behaviours (inconsistent use of condom and multiple partners) are increasingly prevalent in this MSM subpopulation, despite previous educational programmes. The high incidence of risk behaviours among HIV infected patients is particularly worrisome, and must be addressed with innovative interventions and population-based prevention strategies.

Crescer & saúde : desenvolvimento e comportamento dos adolescentes e jovens recém ingressados no 1º ano do ISCED de Benguela, ensino superior público

Ao abordarmos a temática “Crescer & Saúde-Desenvolvimento e Comportamento dos Adolescentes e Jovens Recém-Ingressados no ISCED de Benguela”, enfatizamos a relevância dos aspetos que constituem a sua génese, no sentido de sugerir ações que contribuam para uma educação para a saúde no âmbito do sistema educativo do ensino superior público em Benguela, e a sua promoção na formação de professores. A questão de partida do estudo foi: Qual é a situação dos adolescentes e jovens em matéria de comportamentos de saúde e seus contextos? Para responder à questão, foram desenvolvidos dois estudos: O estudo quantitativo realizado através de um questionário constituído, entre outras, por questões do Health Behaviour School Aged-Children (HBSC) (Currie, et al., 2001, Matos et al., 2002, 2010), contou com um universo estudantil distribuído por nove especialidades. Assim sendo, foi extraída uma amostra de 20% do total de indivíduos que frequentam o primeiro ano, num total de 255 estudantes. O estudo qualitativo, através de grupos focais, contou com 78 indivíduos, distribuídos entre a universidade pública e privada, e teve a finalidade de caracterizar os comportamentos sexuais e outros aspetos relacionados com a saúde nos adolescentes e jovens do 1º ano do ISCED de Benguela. Os resultados refletem a necessidade de uma educação com cariz formativo e informativo que desenvolva ações pedagógicas específicas de dimensão social, presente nas várias instâncias de socialização, através da interação social para que os jovens adquiram normas, atitudes, conhecimentos e comportamentos aceites socialmente. Esperamos que o presente sirva de ferramenta importante para melhor conhecimento dos seus comportamentos, estilo de vida, conhecimentos face ao VIH/SIDA e IST’s, comportamento de risco, saúde mental, atitudes face à diferença e às adversidades, entre outros aspetos, permitindo o exercício de uma influência positiva por parte dos trabalhadores da instituição, dos colegas, familiares e sociedade civil.

Prevalence of antibodies to Hepatitis C virus in populations at low and high risk for sexually transmited diseases in Rio de Janeiro

In order to investigate the sexual transmission of the Hepatitis C Virus (HCV), the prevalence of specific antibodies in populations at high and low risk for sexually transmitted diseases (STDs) was evaluated. The population at low risk for STDs was composed of persons who voluntarity donated blood at the Hospital Universitário Clementino Fraga Filho (HUCFF) between July and November, 1990 (n = 2494). The population at high risk for STDs was drawn from an ongoing study on the natural history of Human Immunodeficiency Virus (HIV) infection (n = 210, 187 with sexual risk factors for HIV infection). All samples were screened using a first generation ELISA. Repeat reactive samples were then tested in a second generation RIBA. For all ELISA positive samples, two sex and age-matched ELISA negative controls were selected. Data pertaining to the presence of antibodies to the Hepatitis B core antigen (anti-HBC antibodies) and to Treponema pallidum were abstracted from the medical records. The prevalence of RIBA 2 confirmed HCV infection among the blood donors was 2.08%, which is well above the reported prevalence in similar populations from developed western countries. Among the HIV infected homosexuals, the encountered prevalence was 7.96% (p < 0.0005). For the whole group with sexually acquired HIV infection, the prevalence was 8.02% (p < 0.000005). Anti-HBc antibodies were more frequently present in anti-HCV RIBA-2 confirmed positive blood donors than in controls (p < 0.001). 33.3% of the HCV-positive blood donors and 11.04% controls were found to be anti-HBc positive (p < 0.0005). As for the FTA-ABs, 17.6% HCV-positive donors and 4,9% controls were positive (p < 0.01). 5.9% samples from blood donors were both anti-HBc and FTA-ABS positive, whereas none of the controls reacted in both tests (p < 0.05). The association between HCV, Hepatitis B infection and syphilis in individuals at low risk for parenterally transmitted diseases suggests that sexual transmission contributes to the maintenance of the endemicity of HCV in the local population.

Occult hepatitis B virus infection among injecting drug users in the Central-West Region of Brazil

The prevalence of occult hepatitis B virus (HBV) infection was investigated in 149 hepatitis B surface antigen (HBsAg) negative injecting drug users (IDUs) in the Central-West Region of Brazil. Of these individuals, 19 were positive for HBV DNA, resulting in an occult HBV infection prevalence of 12.7% (19/149); six of these 19 individuals had anti-HBV core and/or anti-HBV surface antibodies and 13 were negative for HBV markers. All IDUs with occult hepatitis B reported sexual and/or parenteral risk behaviours. All HBV DNA-positive samples were successfully genotyped. Genotype D was the most common (17/19), followed by genotype A (2/19). These findings reveal a high prevalence of occult HBV infection and the predominance of genotype D among IDUs in Brazil's Central-West Region.

Do pornographic websites influence boys' sexual behavior?

Purpose: To compare the sexual behavior of adolescent males who do and do not watch pornographic websites. Methods: This study was presented as a school survey. Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health (SMASH02) database, a survey including 7,548 adolescents age 16-20. The setting was post-mandatory schools in Switzerland. A total of 2,891 male students who connected to the internet in the last 30 days were enrolled and distributed into two groups: boys who deliberately watched pornographic websites in the last 30 days (n ¼ 942; 33%) and boys who did not (n ¼ 1,949; 67%). Socio-demographic characteristics; frequency of connection to the internet; sexual behavior parameters (having a girlfriend and if yes, for more or less than 6 months; having had sexual intercourse; age at first sexual intercourse; use of a condom at last sexual intercourse; number of sexual partners; having made a partner pregnant). Results: A logistic regression was performed using STATA 9.2. The only significant socio-demographic variable was having a low socioeconomic status (adjusted odds ratio [AOR] 1.66); no difference was found for age and academic track between the two groups. Boys who watch pornographic websites were also significantly more likely to connect frequently to the internet (one day a week: AOR 1.75; several days a week: AOR 2.36; every day: AOR 3.11), to have had sexual intercourse (AOR 2.06), and to have had their first sexual intercourse before age 15 (AOR 1.48). The stability of the relationship with their girlfriend did not appear to have any influence on the search for pornography on the internet. Conclusions: About one third of boys in our sample report having accessed pornographic websites in the last 30 days, a proportion similar to other studies. Watching such websites increases with the frequency of connection to the internet and seems to be correlated with an earlier sexual activity debut among adolescent males. However, having had first sexual intercourse before age 15 is the only sexual risk behavior that seems to be increased when watching pornographic websites among boys. Further studies should address the causality of this correlation and the factors influencing the search for pornography on the web among boys, in order to explore some new ways of prevention about sexual risk behaviors. Sources of Support: The SMASH02 survey was carried out with the financial support of the Swiss Federal Office of Public Health and the participating cantons.

Clustering of health behaviours in adult survivors of childhood cancer and the general population.

BACKGROUND: Little is known about engagement in multiple health behaviours in childhood cancer survivors. METHODS: Using latent class analysis, we identified health behaviour patterns in 835 adult survivors of childhood cancer (age 20-35 years) and 1670 age- and sex-matched controls from the general population. Behaviour groups were determined from replies to questions on smoking, drinking, cannabis use, sporting activities, diet, sun protection and skin examination. RESULTS: The model identified four health behaviour patterns: 'risk-avoidance', with a generally healthy behaviour; 'moderate drinking', with higher levels of sporting activities, but moderate alcohol-consumption; 'risk-taking', engaging in several risk behaviours; and 'smoking', smoking but not drinking. Similar proportions of survivors and controls fell into the 'risk-avoiding' (42% vs 44%) and the 'risk-taking' cluster (14% vs 12%), but more survivors were in the 'moderate drinking' (39% vs 28%) and fewer in the 'smoking' cluster (5% vs 16%). Determinants of health behaviour clusters were gender, migration background, income and therapy. CONCLUSION: A comparable proportion of childhood cancer survivors as in the general population engage in multiple health-compromising behaviours. Because of increased vulnerability of survivors, multiple risk behaviours should be addressed in targeted health interventions.