Prior history of sexually transmitted diseases in women living with AIDS in S��o Paulo, Brazil

OBJECTIVES: To describe the epidemiological profile, risk behaviors, and the prior history of sexually transmitted diseases (STDs) in women living with acquired immunodeficiency syndrome (AIDS). METHODS: Cross-sectional study, performed at the Centro de Refer��ncia e Treinamento em DST/AIDS of S��o Paulo. The social, demographic, behavioral, and clinical data such as age, schooling, marital status, age at first sexual intercourse, number of sexual partners, parity, use of drugs, time of HIV diagnosis, CD4 count, and viral load determination were abstracted from the medical records of women living with AIDS who had gynecological consultation scheduled in the period from June 2008 to May 2009. RESULTS: Out of 710 women who were scheduled to a gynecological consultation during the period of the study, 598 were included. Previous STD was documented for 364 (60.9%; 95% CI: 56.9%-64.8%) women. The associated factors with previous STDs and their respective risks were: human development index (HDI) < 0.50 (ORaj = 5.5; 95% CI: 2.8-11.0); non-white race (ORaj = 5.2; 95% CI: 2.5-11.0); first sexual intercourse at or before 15 years of age (ORaj = 4.4; 95% CI: 2.3-8.3); HIV infection follow-up time of nine years or more (ORaj = 4.2; 95% CI: 2.3-7.8)]; number of sexual partners during the entire life between three and five partners (ORaj = 2.2; 95% CI: 1.1-4.6), and six or more sexual partners (ORaj = 3.9; 95% CI: 1.9-8.0%); being a sex worker (ORaj = 1.9; 95% CI: 1.1-3.1). CONCLUSIONS: A high prevalence of a prior history of STDs in the studied population was found. It is essential to find better ways to access HIV infection prevention, so that effective interventions can be more widely implemented.

Vaginal practices as women's agency in sub-Saharan Africa: a synthesis of meaning and motivation through meta-ethnography

This paper reports on a systematic review of qualitative research about vaginal practices in sub-Saharan Africa, which used meta-ethnographic methods to understand their origins, their meanings for the women who use them, and how they have evolved in time and place. We included published documents which were based on qualitative methods of data collection and analysis and contained information on vaginal practices. After screening, 16 texts were included which dated from 1951 to 2008. We found that practices evolve and adapt to present circumstances and that they remain an important source of power for women to negotiate challenges that they face. Recent evidence suggests that some practices may increase a woman's susceptibility to HIV and other sexually transmitted infections. The success of new female-controlled prevention technologies, such as microbicides, might be determined by whether they can and will be used by women in the course of their daily life.

Adolescent Sexual Behavior: Examining Data from Texas and the US

Background: The US has higher rates of teen births and sexually transmitted infections (STI) than other developed countries. Texas youth are disproportionately impacted. Purpose: To review local, state, and national data on teens��� engagement in sexual risk behaviors to inform policy and practice related to teen sexual health. Methods: 2009 middle school and high school Youth Risk Behavior Survey (YRBS) data, and data from All About Youth, a middle school study conducted in a large urban school district in Texas, were analyzed to assess the prevalence of sexual initiation, including the initiation of non-coital sex, and the prevalence of sexual risk behaviors among Texas and US youth. Results: A substantial proportion of middle and high school students are having sex. Sexual initiation begins as early as 6th grade and increases steadily through 12th grade with almost two-thirds of high school seniors being sexually experienced. Many teens are not protecting themselves from unintended pregnancy or STIs ��� nationally, 80% and 39% of high school students did not use birth control pills or a condom respectively the last time they had sex. Many middle and high school students are engaging in oral and anal sex, two behaviors which increase the risk of contracting an STI and HIV. In Texas, an estimated 689,512 out of 1,327,815 public high school students are sexually experienced ��� over half (52%) of the total high school population. Texas students surpass their US peers in several sexual risk behaviors including number of lifetime sexual partners, being currently sexually active, and not using effective methods of birth control or dual protection when having sex. They are also less likely to receive HIV/AIDS education in school. Conclusion: Changes in policy and practice, including implementation of evidence-based sex education programs in middle and high schools and increased access to integrated, teen-friendly sexual and reproductive health services, are urgently needed at the state and national levels to address these issues effectively.

It's your game, keep it real. Sexual education study

Purpose: This study translated and adapted the It's Your Game, Keep It Real study currently being implemented with middle school youth in Southeast Texas for a middle school population in rural western Honduras. The study tested the effects of a sexual health education program focused on human immunodeficiency virus, sexually transmitted infections, and pregnancy prevention. We hypothesized that the number of adolescents in the intervention group who initiate sexual activity will reduce in comparison to the control group and there will be an increase consistent condom use in sexually active adolescents in the intervention group. ^ Methods: The target population included Spanish-speaking Hispanic middle school students from a small, semi-urban city in western Honduras. One school was randomly selected to receive the intervention and one to the comparison condition. The intervention curriculum consisted of 10 seventh-grade lessons that included individual and group classroom-based activities and personal journaling. Follow-up surveys were completed three months after the last lesson with 146 students (79.3% of the defined cohort). ^ Results: In the comparison condition, 21.4% of students initiated sex by the post-test follow-up three months after the intervention compared to 7.8% in the intervention condition. ^ Conclusions: A multi-component, curriculum-based program that is theory driven and culturally relevant can increase knowledge about STIs and HIV, increase self-confidence amongst middle school students, and develop communication skills amongst friends and partners. Further research must be conducted to assess delay in sexual initiation and the generalizability of these results.^

Pr��cticas de autocuidado sexual y reproductivo en mujeres ���parejas de��� migrantes internacionales de San Luis Potos��, M��xico

Los migrantes y sus parejas han sido incorporados en los discursos institucionales de salud como ���sujetos en riesgo��� frente a las Infecciones de Trasmisi��n Sexual (ITS), sin embargo la incorporaci��n de esta poblaci��n espec��fica en la comunicaci��n y gesti��n del riesgo de ITS ha sido ambigua en el contexto mexicano. El objetivo del presente acercamiento fue conocer las pr��cticas de autocuidado sexual y reproductivo que adoptan en su cotidianeidad mujeres parejas de migrantes y la relaci��n de dichas medidas con la comunicaci��n y gesti��n del riesgo que los Servicios de Salud realizan. Se trat�� de una aproximaci��n de tipo cualitativo con 20 mujeres ���de migrantes��� localizadas mediante los servicios de salud, la informaci��n se recab�� a trav��s de entrevistas a profundidad que focalizaron en las esferas de ���percepci��n del riesgo��� y ���Autocuidado sexual y reproductivo���. Se encontr�� que la mayor��a de las mujeres no se reconoce vulnerable frente a las ITS y que la percepci��n del riesgo no es determinante en la confrontaci��n que respecto a la amenaza puedan desarrollar, dado que los imaginarios patriarcales que prevalecen en ellas, sus parejas y el personal de salud desestiman la utilizaci��n de medidas de prevenci��n y detecci��n oportuna.

A import��ncia da metodologia das oficinas formativas na educa����o sexual na escola

Enquadramento: O interesse pelo tema Educa����o Sexual germinou da conscientiza-����o de que a sexualidade est�� na ess��ncia do homem, com o ideal de ser experimentada e vivida; procura-se cada vez mais expandir esses conhecimentos com responsabilidade e naturalidade, principalmente frente �� responsabilidade de educadores por participar de uma capacita����o oferecida pelo grupo do Instituto Kaplan Programa / PROJETO VALE SONHAR. Objetivo: Proposemo-nos analisar a importancia da metodologia das oficinas formati-vas na Educa����o Sexual na Escola;Determinar a efic��cia das oficinas nos conhecimentos sobre sexualidade nos adolescentes;Construir conhecimento sobre sexualidade, desmitifi- cando conceitos. M��todo: Foi desenvolvida uma interven����o formativa com aplica����o de 03 (tr��s) ofi-cinas, em que foram avaliados os conhecimentos antes e ap��s a interven����o formativa. Du-rante estas oficinas foram aplicados question��rios e coleta de depoimentos dos participantes. A amostra foi constitu��da por adolescentes de ambos os sexos, que frequentavam o 1�� ano do ensino m��dio na Escola Estadual de Educa����o B��sica Costa R��go, no ano letivo de 2013 e 2014. Resultados: Os conhecimentos sobre planejamento familiar, infec����es sexualmente transmiss��veis e reprodu����o dos adolescentes na maioria aumentaram ap��s a interven����o formativa no ��mbito da afetividade/sexualidade na adolesc��ncia. Os conhecimentos est��o relacionados com a idade no sentido em que s��o os mais novos que demonstram mais co-nhecimentos. Na separa����o dos conhecimentos por sexo s��o as meninas que manifestam mais conhecimentos, assim como os residentes em meio urbano. A exist��ncia de irm��os, a idade e escolaridade dos pais n��o influenciam os conhecimentos dos adolescentes. Obser-vou-se tamb��m que os adolescentes que j�� tinham iniciado rela����es sexuais s��o aqueles que det��m menos conhecimentos. Conclus��o: Os dados mostram que as oficinas realizadas e os question��rios servi-ram para conscientiza����o dos alunos e contribuiu para a redu����o dos ��ndices de evas��o escolar por motivos de gravidez, mostrando assim a import��ncia de se tratar de educa����o sexual no ambiente escolar. Palavras-chave: Adolesc��ncia, Sexualidade, Educa����o Sexual, Planejamento Famili-ar, Infec����es Sexualmente Transmiss��veis.

Gender differences in the influence of protective factors, risk factors, and health risk behaviors on HIV risk behaviors among youth in South Florida

Adolescents engage in a range of risk behaviors during their transition from childhood to adulthood. Identifying and understanding interpersonal and socio-environmental factors that may influence risk-taking is imperative in order to meet the Healthy People 2020 goals of reducing the incidence of unintended pregnancies, HIV, and other sexually transmitted infections among youth. The purpose of this study was to investigate gender differences in the predictors of HIV risk behaviors among South Florida youth. More specifically, this study examined how protective factors, risk factors, and health risk behaviors, derived from a guiding framework using the Theory of Problem Behavior and Theory of Gender and Power, were associated with HIV risk behavior. A secondary analysis of 2009 Youth Risk Behavior Survey data sets from Miami-Dade, Broward, and Palm Beach school districts tested hypotheses for factors associated with HIV risk behaviors. The sample consisted of 5,869 high school students (mean age 16.1 years), with 69% identifying as Black or Hispanic. Logistic regression analyses revealed gender differences in the predictors of HIV risk behavior. An increase in the health risk behaviors was related to an increase in the odds that a student would engage in HIV risk behavior. An increase in risk factors was also found to significantly predict an increase in the odds of HIV risk behavior, but only in females. Also, the probability of participation in HIV risk behavior increased with grade level. Post-hoc analyses identified recent sexual activity (past 3 months) as the strongest predictor of condom nonuse and having four or more sexual partners for both genders. The strongest predictors of having sex under the influence of drugs/alcohol were alcohol use in both genders, marijuana use in females, and physical fighting in males. Gender differences in the predictors of unprotected sex, multiple sexual partners, and having sex under the influence were also found. Additional studies are warranted to understand the gender differences in predictors of HIV risk behavior among youth in order to better inform prevention programming and policy, as well as meet the national Healthy People 2020 goals.

Age Differences among Female Sex Workers in the Philippines: Sexual Risk Negotiations and Perceived Manager Advice

Consistent condom use among high risk groups such as female sex workers (FSWs) remains low. Adolescent female sex workers are especially at higher risk for HIV/STI infections. However, few published studies have compared the sexual risk negotiations among adolescent, emerging adult, and older age groups or the extent a manager���s advice about condom use is associated with an FSW���s age. Of 1,388 female bar/spa workers surveyed in the southern Philippines, 791 FSW who traded sex in the past 6 months were included in multivariable logistic regression models. The oldest FSWs (aged 36���48) compared to adolescent FSWs (aged 14���17) were 3.3 times more likely to negotiate condoms when clients refused condom use. However, adolescent FSWs received more advice from their managers to convince clients to use condoms or else to refuse sex, compared to older FSWs. Both adolescent and the oldest FSWs had elevated sexually transmitted infections (STIs) and inconsistent condom use compared to other groups. Having a condom rule at the establishment was positively associated with condom negotiation. Factors such as age, the advice managers give to their workers, and the influence of a condom use rule at the establishment need to be considered when delivering HIV/STI prevention interventions.

Molecular epidemiology of sexually transmitted human papillomavirus in a self referred group of women in Ireland

Background: Human papillomavirus (HPV) causes cervical cancer and external genital warts. The purpose of this study is to document the genotype distribution of HPV in females aged between 18 and 34 who self-referred to an STI clinic with visible external genital warts (EGW). Scrapings were taken from visible external genital warts (EGW). These scrapings were analysed by PCR for the presence of HPV DNA. Positive samples were then genotyped by means of a commercially available assay (LiPA). A comparison of genotyping results determined by the LiPA assay and direct amplicon DNA sequencing was also performed. Results: Ninety-two patients out of 105 samples (88%) had detectable levels of HPV DNA. The majority of individuals with EGW (66%) showed the presence of two or more genotypes. The most common HPV genotypes present in the study population were HPV-6, HPV-11, HPV-16, HPV-18, HPV-33 and HPV-53. Potential effects of vaccination on HPV molecular epidemiology indicate that 40% of the patients could have been protected from the high risk genotypes HPV-16 and HPV-18.Conclusion: This is the first report of the molecular epidemiology of external genital warts in women aged between 18 and 34 from Ireland based on results from a LiPA assay. The study shows that most individuals are infected with multiple genotypes including those with high oncogenic potential and that the newly available HPV vaccines could have a significant impact on prevalence of the most common HPV genotypes in this study population.

Relat��rio de est��gio

Este relat��rio destina-se a descrever as ac����es desenvolvidas no est��gio, do 1�� Curso de Mestrado em Enfermagem Comunit��ria, realizado na Escola Superior de Sa��de de Portalegre. A interven����o comunit��ria, realizou-se na comunidade escolar de Portalegre, tendo tido duas vertentes: Educa����o sexual na adolesc��ncia; Promo����o de comportamentos saud��veis nos estilos de vida dos adolescentes. As a����es realizadas abordaram a educa����o sexual na adolesc��ncia, com base no diagn��stico de situa����o e, atrav��s da elabora����o de um projecto de interven����o, aplicado em metodologia de planeamento em sa��de. A interven����o comunit��ria teve como base a promo����o de comportamentos saud��veis nos estilos de vida dos adolescentes, a alunos das escolas de Portalegre do 9�� e 12�� anos, na ��rea de ci��ncias e tecnologias. Todo este trabalho foi desenvolvido na fase te��rica e suportou a nossa interven����o em est��gio. Assim, ap��s a conclus��o deste diagn��stico, seguiu-se a fase de estabelecimento de prioridades, fixa����o dos objectivos, selec����o de estrat��gias, prepara����o da execu����o e avalia����o. Na adolesc��ncia, a educa����o sexual dever�� ser orientada para a matura����o psicossexual, para os afetos, para a contrace����o e planeamento familiar e para a preven����o de doen��as. �� da responsabilidade dos profissionais de sa��de, da escola, mas sobretudo da fam��lia, proporcionar um ambiente favor��vel �� aprendizagem e ao di��logo. O realce da educa����o sexual, dever�� ser colocado na igualdade de pap��is, na toler��ncia face ao pluralismo de orienta����o e de condutas sexuais. Por outro lado, �� tamb��m na adolesc��ncia, que se adquirem h��bitos e comportamentos saud��veis. Assim, os profissionais de sa��de, conjuntamente com a escola e a fam��lia, poder��o ter um papel preponderante, capacitando os jovens de compet��ncias que lhes permitam optar por comportamentos saud��veis, a n��vel de alimenta����o, ��lcool, uso de drogas, preven����o de infec����es sexualmente transmiss��veis e cidadania

Gender Differences in the Influence of Protective Factors, Risk Factors, and Health Risk Behaviors on HIV Risk Behaviors Among Youth in South Florida

Adolescents engage in a range of risk behaviors during their transition from childhood to adulthood. Identifying and understanding interpersonal and socio-environmental factors that may influence risk-taking is imperative in order to meet the Healthy People 2020 goals of reducing the incidence of unintended pregnancies, HIV, and other sexually transmitted infections among youth. The purpose of this study was to investigate gender differences in the predictors of HIV risk behaviors among South Florida youth. More specifically, this study examined how protective factors, risk factors, and health risk behaviors, derived from a guiding framework using the Theory of Problem Behavior and Theory of Gender and Power, were associated with HIV risk behavior. A secondary analysis of 2009 Youth Risk Behavior Survey data sets from Miami-Dade, Broward, and Palm Beach school districts tested hypotheses for factors associated with HIV risk behaviors. The sample consisted of 5,869 high school students (mean age 16.1 years), with 69% identifying as Black or Hispanic. Logistic regression analyses revealed gender differences in the predictors of HIV risk behavior. An increase in the health risk behaviors was related to an increase in the odds that a student would engage in HIV risk behavior. An increase in risk factors was also found to significantly predict an increase in the odds of HIV risk behavior, but only in females. Also, the probability of participation in HIV risk behavior increased with grade level. Post-hoc analyses identified recent sexual activity (past 3 months) as the strongest predictor of condom nonuse and having four or more sexual partners for both genders. The strongest predictors of having sex under the influence of drugs/alcohol were alcohol use in both genders, marijuana use in females, and physical fighting in males. Gender differences in the predictors of unprotected sex, multiple sexual partners, and having sex under the influence were also found. Additional studies are warranted to understand the gender differences in predictors of HIV risk behavior among youth in order to better inform prevention programming and policy, as well as meet the national Healthy People 2020 goals.

Predictors of genital warts among women attending two family planning clinics

Objectives: To establish the prevalence and predictors of genital warts among healthy women presenting for contraceptive advice at two family planning clinics, one in a major Australian city and one in a country town in the same state. Methods: Consecutive consenting attendees (n = 1218)at two family planning clinics in Queensland completed a questionnaire and were examined for genital warts. Results: The point prevalence of visible genital warts was 3.3 per cent in the city clinic and 14.4 per cent in the country town. For half of these clients a finding of warts was unexpected, in that the client was unaware of their presence and presentation to the family planning clinic was not specifically for advice about sexually transmitted infections. The major predictor of a finding of warts was client age, with the highest prevalence in 20- to 25-year-olds. Warts were also commoner amongst smokers in the country town but not in Brisbane. However, no analysed sociodemographic variable predicted a finding of warts of which the client was not aware. Conclusions: Genital warts are common among young women presenting for contraceptive advice. Such women are often unaware that they have warts. Examination for genital warts should be a part of any routine examination of sexually active women, and medical practitioners should be aware of appropriate advice for patients who are found to have genital warts on routine examination.

Vaginal douching and vaginal substance use among sex workers in KwaZulu-Natal, South Africa

A local cultural practice that may enhance sexually transmitted infections (STIs) and HIV transmission is vaginal douching and vaginal substance use. These activities also have potential implications for the acceptability of HIV-prevention strategies such as the use of condoms and vaginal microbicides. We aimed to establish the prevalence, determinants and reasons for these practices among sex workers in KwaZulu-Natal, South Africa. A structured questionnaire was administered to 150 sex workers, who were being screened for a vaginal microbicide-effectiveness trial in the province. The questionnaire sought information on the frequency, reasons for and nature of vaginal douching and vaginal substance use and was drawn up on the basis of findings from a pilot study. Seventy per cent (95% CI: 62.0-77.2%) of the sex workers were HIV positive and on average they had five sexual partners per day. Vaginal douching and vaginal substance use were common among the sex workers. Vaginal douching was reported by 97% (n = 146) of the respondents and 94% reported vaginal substance use for 'dry sex'. A combination of traditional remedies, patent medicines, antiseptics and household detergents was used to clean and make the vagina dry and tight. The primary reasons reported for dry sex were to increase men's sexual pleasure (53%) and to attract clients and generate more money (20%). Sixty-five per cent of the women reported the practice of douching mainly for hygienic purposes and 13% for the prevention and treatment of sexually transmitted infections. Douching and dry-sex practices may increase women's risk of HIV and STI infection, and may have implications for the acceptability and development of HIV-prevention barrier methods such as microbicides and the use of condoms. These barrier methods may enhance or reduce sexual pleasure for men and women who engage in the practice of vaginal douching and vaginal substance use for 'dry sex'.

Early life course determinants of young adults' gambling behaviour. An Australian Longitudinal Study

Problem gambling represents a public concern as both a social and health issue. Available evidence shows problem gambling is associated with a range of psychological disorders, criminality, and disruption to families. While gambling itself may represent a pleasurable pursuit for the majority, for a proportion, gambling-related activities may assume many of the characteristics of an addiction and have the capacity to undermine individuals��� mental and physical health, social relationships, financial independence, as well as the financial and psychological wellbeing of their families and/or friends. The objectives of this study are based on the need to increase our understanding of gambling behaviour, its antecedents, as well its influence on the health and wellbeing of gamblers and their families. One of the most important and unresolved issues in gambling research is whether the mental health and social/family correlates of gambling precede or follow gambling behaviour. This report focuses on this issue.