A pragmatic intervention to promote condom use by female sex workers in Thailand.
(73/2672)
An overview is presented of a multifaceted intervention to promote consistent condom use by female commercial sex workers in Thailand, in the context of the government's 100% condom use policy for preventing spread of human immunodeficiency virus (HIV) infection. The project is described with reference to a succession of stages including pre-programme needs assessment, intervention design, implementation and evaluation. The key elements of the intervention were video scenarios and discussions coordinated by health personnel, and video-depicted open-ended narratives aimed at helping sex workers to explore their personal and work-related dilemmas and concerns. A core objective was to enhance sex workers' self-esteem and perceived future with a view to strengthening their motivation to take preventive action against HIV infection. The intervention was evaluated using a combination of qualitative (process evaluation) and quantitative (outcome) methods. The outcome evaluation was undertaken using a pretest, post-test intervention and control group quasi-experimental design. There were significant increases in consistent condom use among the intervention groups but not among the controls. Pragmatic stability is advocated for the Thai sex industry and recommendations are offered for good quality HIV prevention activities. (+info)
Reproductive health and intimate partner violence.(74/2672)
Highlights of the sexual activity of the heterosexual population in the province of Quebec.
(75/2672)
OBJECTIVES: To describe and quantify the level of sexual activity of the heterosexually active population of Quebec. METHODS: The data analysed included 2889 heterosexually active individuals aged 15-60 (agemed = 32) from a 1996-7 survey on the sexual lifestyles of the general population of Quebec. Various probability distributions were studied to assess their capacity to describe and quantify the lifetime and yearly numbers of sexual partners of the sampled population. To estimate the annual rates of new partner acquisition, a generalised linear model was fitted to the number of lifetime sexual partners as a function of age, years of sexual activity, and sex. RESULTS: The mean and variance of the number of lifetime sexual partners for men (mean = 11, s2 = 163) is higher than for women (mean = 6, s2 = 72). The negative binomial and lognormal probability distributions give the most adequate fit to the lifetime number of partners for both agglomerated and stratified (by sex and age) data. The estimated annual rates of new partner acquisition provide two important results for prevention: (1) the first year of sexual activity represents the highest annual rate of new partner acquisition independent of age, (2) annual rates of new partner acquisitions increase through mid-life (ages 40-50) combined with a decrease in condom use. CONCLUSION: Problems caused by the use of large categories in the estimation of mean and variance cannot totally be overcome by fitting probability distributions to the empirical data despite good fits. Furthermore, we believe that adequate estimates of the annual rate of new partner acquisition should be a better measure of the risk of HIV infection than the number of partners since the first is a measure of incidence while the second is a measure of prevalence. (+info)
Risky business: health and safety in the sex industry over a 9 year period.
(76/2672)
OBJECTIVES: To assess whether a previously established low sexually transmitted infection/HIV risk in prostitutes in London has been sustained, and to measure other occupational risks, including mortality. DESIGN: 9 year prospective study in west London. SUBJECTS: 402 prostitutes recruited from 1985 to 1991, 320 were followed up for 675 person years to 1994. MAIN OUTCOME MEASURES: Condom use in commercial and non-commercial sex; viral and bacterial sexually transmitted infection at initial and follow up visits; death. RESULTS: Condom use increased significantly from 1986 to 1993 and protected the majority of commercial sexual contacts. Baseline prevalence: HIV 1.3%, hepatitis C 6.7%, hepatitis B 6.6%, syphilis 2.3%, HTLV-I/II 0.4%, gonorrhoea 3.0%, chlamydia 8.2%, genital herpes 16.8%. Incidence (per 100 person years): HIV 0.2, hepatitis C 0.3, gonorrhoea 5.6, chlamydia 12.6, genital herpes 6.5. Viral infections were associated with injecting drug use and non-British nationality; bacterial infections were associated with numbers of non-commercial partners but not with sexual contacts at work. Four women died during the course of the study; two had AIDS, two were murdered. This mortality of 5.93 per 1000 person years was 12 times the expected rate for women of a similar age. CONCLUSIONS: This study shows that it is possible to have a larger number of sexual partners and remain free from sexually transmitted infections provided that condoms are used consistently: there has been a sustained increase in condom use in the sex industry. None the less, prostitutes are at increased risk of sexually transmitted infections, primarily through non-commercial sexual partnerships. Infectious diseases are only one of the risks facing prostitutes, as illustrated by the mortality from violence as well as from HIV infection. (+info)
Young working women utilise the after hours service at Sydney Sexual Health Centre.
(77/2672)
OBJECTIVE: To analyse patterns of patient utilisation of the after hours service at Sydney Sexual Health Centre (SSHC). METHOD: A retrospective cross sectional database study compared all new daytime and after hours patients who registered for a medical consultation at SSHC between August 1994 and February 1995. Daytime and after hours attenders were compared using demographic and behavioural factors and for prevalence of STDs and HIV using logistic regression analysis. RESULTS: Of the 1662 eligible patients, 1362 (81.9%) attended during daytime hours, and 300 (18.1%) attended after hours. There was no significant difference in after hours attendance between patients living in inner compared with outer metropolitan zones. Using logistic regression analysis, being female (p = 0.0008), being between 20 and 39 years of age (p = 0.008), being employed (p < 0.001), and having no previous STD/genitourinary condition (p = 0.034) were the factors significantly associated with after hours attendance. CONCLUSIONS: The evening service was disproportionately utilised by a patient group not defined as "high risk" in the objectives of the service. This study challenges the assumption that evening clinics are always the way to reach high risk groups. (+info)
Bacterial vaginosis is not associated with circumcision status of the current male partner.
(78/2672)
OBJECTIVE: Bacterial vaginosis (BV) is common in sexually active women, and in a large proportion the underlying aetiology is unknown. We evaluated partner circumcision status as a potential risk and hypothesised that women with uncircumcised partners were at increased risk for BV. METHODS: Retrospective audit of a partner study (272 heterosexual couples) conducted in Baltimore between 1990 and 1992. BV defined by clinical criteria and circumcision status of males was determined by physical examination. RESULTS: BV was diagnosed in 83 (30%) female partners; 75 (27%) males were uncircumcised. In males and females respectively, gonorrhoea was diagnosed in 20% and 16%, and chlamydia in 7% and 11%. In women with circumcised partners, 58/197 (29%) had BV compared with 25/75 (33%) with uncircumcised partners (p = 0.53). CONCLUSION: Women with uncircumcised current partners are not at increased risk for BV. (+info)
Cervical cytology: are national guidelines adequate for women attending genitourinary medicine clinics?
(79/2672)
OBJECTIVES: To study whether all women attending a genitourinary medicine (GUM) clinic warrant a cervical smear as part of a routine screen for infection, or whether this "at risk" population is adequately covered by the national screening programme. METHODS: A cervical smear and a screen for sexually transmitted infections (STI) were taken from 900 women attending a GUM clinic between May 1996 and April 1997. RESULTS: Of 812 smears available for analysis, 613 (75.5%) were normal, 176 (21.7%) were mildly abnormal, and 23 (2.8%) were moderately or severely abnormal. In the absence of an STI there was a 14% (37/273) risk of having an abnormal cervical smear. In the presence of cervicitis the risk was 26% (22/84) and with genital warts the risk was 34% (75/215). CONCLUSION: The national screening programme guidelines for cervical cytology should be followed in the GUM clinic. There is no benefit in performing extra smears outside the programme nor in adopting a policy of universal screening. (+info)
In vitro and in vivo evaluations of sodium lauryl sulfate and dextran sulfate as microbicides against herpes simplex and human immunodeficiency viruses.
(80/2672)
The efficacy of sodium lauryl sulfate (SLS), a sulfated anionic chaotropic surfactant, and dextran sulfate (DS), a polysulfated carbohydrate, against herpes simplex virus (HSV) and human immunodeficiency virus (HIV) infections was evaluated in cultured cells and in different murine models of HSV infection. Results showed that both SLS and DS were potent inhibitors of the infectivities of various HSV-1 and HSV-2 strains. Pretreatment of HIV-1 (strain NL4-3) with SLS also reduced its infectivity to 1G5 cells. DS prevented the binding of HSV to cell surface receptors and therefore its entry into cells. Pretreatment of HSV-1 (strain F) with 50 microM SLS resulted in a complete loss of virus infectivity to Vero cells. However, viruses were able to enter into cells and to produce in the nuclei capsid shells devoid of a DNA core. The amount of the glycoprotein D gene produced in these cells remained unchanged compared to controls, suggesting that SLS could interfere with the maturation of the virus. At a higher SLS concentration (100 microM), HSV was highly damaged by SLS pretreatment and only a few viral particles could enter into cells to produce abnormal capsids. Although DS was a more potent inhibitor of HSV infectivity in vitro, it was unable to provide any protection in murine models of HSV infection. However, SLS conferred a complete protection of animals infected cutaneously with pretreated viruses. In addition, skin pretreatment of mice with a polymer formulation containing SLS completely prevented the development of cutaneous lesions. More interestingly, intravaginal pretreatment of mice with SLS in a buffered solution also completely protected against lethal HSV-2 infection. Taken together, our results suggest that SLS could thus represent a candidate of choice as a microbicide to prevent the sexual transmission of HIV, HSV, and possibly other pathogens that cause sexually transmitted diseases. (+info)