Is ‘bareback’ a useful construct in primary HIV‐prevention? Definitions,identity and research

This paper discusses sexual health strategies among Chilean women living in Melbourne, Australia. Twenty in-depth qualitative interviews and a survey questionnaire were administered to 100 Chilean-born women. Findings illustrate the importance of 'authority' when it comes to 'socially risky' illnesses like sexually transmitted diseases (STDs). Women stressed that western trained doctors are the only answer for STDs and the only way women can protect themselves from getting STDs is by visiting the doctor. The western trained doctor is seen to have the authority and legitimacy to treat the disease and heal the social relationships threatened by STDs. Chilean women continue to value the importance of alternative medicine within the array of health and medical seeking behaviours, although their use has shifted from the traditional Latin American folk healer to the Chinese doctor, herbalist and other alternative medical practitioners, including naturopaths. We conclude by arguing that while traditional medicines are still widely used by the Chilean migrant community, when it comes to 'socially risky' conditions such as STDs, western trained doctors, because of their conferred power, authority and social legitimacy, are key figures for prevention and treatment.     

皮肤科性病门诊管理模式初探

随着性病发病率不断增长,皮肤科性病门诊作为性病患者主要的集中场所,其治疗和管理工作日显重要。为了给性病患者努力营造一个宽松的就医环境,同时便于性病蔓延的控制,避免院内交叉感染,从加强就医环境管理、患者管理、医疗用品和医务人员的管理模式出发,对这一问题作了初步探讨。     

The fight against sexually transmitted diseases in Ivory Coast: what strategies can we use in the face of HIV/AIDS?

In the AIDS era, sexually transmitted diseases (STDs) have become a major health problem in developing countries, particularly in Africa. Delays in the diagnosis and treatment of such infections may result in complications, many of which primarily affect women. Epidemiological studies in Abidjan have shown that more than 10% of the pregnant women attending antenatal clinics present STDs potentially serious for their own health or that of their infants (gonorrhea, chlamydia infection, genital ulcers or active syphilis). There is evidence that STDs increase the transmission of HIV and that improving the syndromic management of STDs reduces the incidence of HIV infection. This provides a strong argument in favor of controlling STDs in areas of high HIV prevalence. In Ivory Coast, as in other African countries, a STD control program has been integrated into the AIDS control program since 1992, as recommended by the World Health Organization. During the first six years of the STD program, considerable progress was made in some areas, but not without difficulty. Simple syndrome-based decision trees have been adopted for the management of STDs in primary health care. Clinical studies have shown these therapeutic algorithms to be effective. At the same time, effective and affordable drugs for treating STDs were added to the list of essential drugs in Ivory Coast, after an international invitation to tender. The entire staff of the public health sector in Abidjan has been trained in syndromic STD management. Training is now being extended to other parts of Ivory Coast, including the private health sector and, in particular, private nurses. The surveillance of syndromic STDs, mainly genital ulcers in both sexes and urethral discharge in men, facilitates monitoring and evaluation of the STD program, following health care activities and adapting orders for drugs for treating STDs to real needs. In the near future, some parts of the STD program will be strengthened, particularly the management of sexual partners of STD patients and reduction of the cost of STD treatment for pregnant women.     

A different type of medicine: women's experiences with ophthalmic diseases in rural and urban Tamil Nadu, India

I conducted a study to understand how urban and rural women conceptualized eye diseases in Tamil Nadu state(1). I chose to examine eye diseases because ailments such as cataracts, glaucoma, refractive error, and diabetic retinopathy rank among the most serious diseases of Indian women. I collected observational, survey, and interview data to compare women from rural and urban areas. In line with my expectations, rural women were more likely to rely upon non-medical means of treatment than their urban counterparts. Contrary to expectations, however, I found that urban and rural Tamil women's overall dependence on nonmedical means was not excessive. Based on the study's findings, it appears that both urban and rural women express a marked preference for both traditional and modern medical treatments - a phenomenon that is known as medical pluralism. Rural participants expressed a greater interest in medical pluralism than their urban counterparts. The results of the study lead me to believe that medical pluralism may be associated with the patient's geographic residence. I conclude this article with a discussion of the consequences of medical pluralism for women's health and overall societal development in Tamil Nadu.     

Testing for sexually transmitted diseases among women of reproductive age: United States, 1988.

Approximately 13.3 million women aged 15-44--about 26 percent of all women of reproductive age who had ever had intercourse--were tested for sexually transmitted diseases (STDs) in the 12 months before the 1988 National Survey of Family Growth. Slightly over half of the women tested received the test as part of a family planning visit. Women who used clinics for family planning services were most likely to be tested--54 percent compared with 34 percent of women who used a private doctor for family planning and 16 percent of women who did not receive family planning services that year. The findings suggest that access to medical care, especially access to family planning clinics, has strong effects on a woman's chances of being screened for STDs, independent of her individual characteristics. The most important individual characteristic affecting the chance of being tested for an STD was race: About 47 percent of black, 27 percent of Hispanic, and 23 percent of white and other women were tested in the 12 months before the survey. Among groups with high-risk behaviors, only 34 percent of sexually experienced teenagers were screened for STDs in the past year, as were only 43 percent of women with a positive STD history and 32 percent of women with 10 or more lifetime partners.     

Racial misclassification of American Indians in Oklahoma State surveillance data for sexually transmitted diseases

The burden of sexually transmitted diseases (STDs) is high in American Indian/Alaska Native (AI/AN) populations. In addition, race is often misclassified in surveillance data. This study examined potential racial misclassification of American Indians in STD surveillance data in Oklahoma. Oklahoma State STD surveillance data for 1995 were matched with the Oklahoma State Indian Health Service Patient Registry to determine the number of AI/AN women who had one of three STDs but were not listed in Oklahoma surveillance data as AI/AN. Accounting for racial misclassification increased the rate of chlamydia for AI/AN women in Oklahoma by 32% (342/100,000 vs. 452/100,000) in the overall population. For gonorrhea, the rate increased by 57% (94/100,000 vs. 148/100,000) and for syphilis by 27% (15/100,000 vs. 19/100,000). Misclassified AI/AN women most often were classified as "White," and the likelihood of misclassification increased with a lower percentage of AI/AN ancestry. These findings indicate that STD rates may be underestimated for AI/AN populations nationwide. Racial misclassification in state surveillance data causes inaccuracies in characterizing the burden of infectious diseases in minorities.     

Where do people go for treatment of sexually transmitted diseases?

CONTEXT: Major public health resources are devoted to the prevention of sexually transmitted diseases (STDs) through public STD clinics. However, little is known about where people actually receive treatment for STDs. METHODS: As part of the National Health and Social Life Survey, household interviews were performed from February to September 1992 with 3,432 persons aged 18-59. Weighted population estimates and multinomial response methods were used to describe the prevalence of self-reported STDs and patterns of treatment utilization by persons who ever had a bacterial or viral STD. RESULTS: An estimated two million STDs were self-reported in the previous year, and 22 million 18-59-year-olds self-reported lifetime STDs. Bacterial STDs (gonorrhea, chlamydia, nongonococcal urethritis, pelvic inflammatory disease and syphilis) were more common than viral STDs (genital herpes, genital warts, hepatitis and HIV). Genital warts were the most commonly reported STD in the past year, while gonorrhea was the most common ever-reported STD. Almost half of all respondents who had ever had an STD had gone to a private practice for treatment (49%); in comparison, only 5% of respondents had sought treatment at an STD clinic. Respondents with a bacterial STD were seven times more likely to report going to an STD clinic than were respondents with a viral STD--except for chlamydia, which was more likely to be treated at family planning clinics. Men were significantly more likely than women to go to an STD clinic. Young, poor or black respondents were all more likely to use a family planning clinic for STD treatment than older, relatively wealthy or white respondents. Age, sexual history and geographic location did not predict particular types of treatment-seeking. CONCLUSIONS: The health care utilization patterns for STD treatment in the United States are complex. Specific disease diagnosis, gender, race and income status all affect where people will seek treatment. These factors need to be taken into account when STD prevention strategies are being developed.     

Sexually transmitted diseases and HIV/AIDS: Nursing discussion about dangerous relations for women

The present article has as its main objective the discussion of the risky relationship between sexually transmitted diseases (STDs) and the HIV/AIDS under the perspective of gender and sexuality. It presents the increase of AIDS among women as a consequence of social, political, cultural and economic relations. The study uses an exploratory methodology of qualitative nature. It focuses on women who are HIV positive and acquired the disease through sexual relationships with a stable partner. The study concluded that nursing care is a very important opportunity for nurses to make an early diagnosis, treatment and prevention of the STDs and AIDS.     

Gender gaps,gender traps: sexual identity and vulnerability to sexually transmitted diseases among women in Vietnam

We conducted a qualitative study to explore the pathways by which traditional gender roles may ultimately affect Vietnamese women's interpretation of sexually transmitted disease (STD) symptoms and health-seeking strategies. Data on gender roles, perceptions of types of sexual relationships, perceptions of persons with STDs, and STD patient experiences were gathered through in-depth interviews and focus groups with 18 men and 18 women in the general population of northern Vietnam. A framework integrating Andersen's behavioral model of health services use and Zurayk's multi-layered model was used to conceptualize women's health-seeking behavior for STD symptoms. Both men and women noted clear gender differences in sexual roles and expectations. According to participants, a woman's primary roles in northern Vietnam are socially constructed as that of a wife and mother-and in these roles, she is expected to behave in a faithful and obedient manner vis à vis her husband. It emerged that men's marital and sexual roles are less clearly defined by traditional norms and are more permissive in their tolerance of premarital and extramarital sex. For women, however, these activities are socially condemned. Finally, since STDs are associated with sexual promiscuity, both men and women expressed anxiety about telling their partners about an STD; women's expressions were characterized more by fear of social and physical consequences, whereas men expressed embarrassment. Community level interventions that work towards disassociating STDs from traditional social norms may enable Vietnamese women to report possible STD symptoms and promote diagnosis and care for STDs.     

Predictors of STDs among Asian and Pacific Islander young adults

CONTEXT: Limited information is available on factors associated with STDs among Asian and Pacific Islander young adults. Such information is vital to developing effective interventions to reduce STDs within this group. METHODS: Data were derived from the National Longitudinal Study of Adolescent Health, Wave 3; the sample consisted of 605 female and 578 male Asian and Pacific Islander young adults. Logistic regression analysis was used to assess factors associated with ever having had an STD. RESULTS: Thirteen percent of females and 4% of males had ever had an STD. Among those who had had an STD, 75% were female, 9% had ever been paid for sex, 31% had had sex before age 15 and 55% had had multiple sex partners in the previous 12 months. Being female (odds ratio, 4.1), being Indian (compared with being Filipino; 4.8), having ever been paid money for sex (4.7) and having had more than one sex partner in the past 12 months (2.5) were associated with increased odds of having had an STD diagnosis. The more respondents believed that STDs were responsive to treatment, the greater their odds of having had an STD (2.3); the more they believed that STDs had negative consequences for a relationship, the lower their odds of having had an STD (0.7). CONCLUSIONS: Asian and Pacific Islander women and Indians are priority groups for both research and clinical attention; prevention efforts to reduce STDs should be tailored to these groups. Clinicians working with Asians and Pacific Islanders need to focus on clients' number of sexual partners and health-related beliefs.     

Impurity and danger: the need for new barriers and bridges in the prevention of sexually-transmitted disease in the Tari Basin, Papua New Guinea

The Huli of the Tari Basin have a serious problem with the spread of STDs following the opening of the Highlands Highway from Mendi in the early 1980s. Huli territory is now the site of huge mineral exploration and development and fears are held by health officers that the diseases may soon become an epidemic. The likelihood of AIDS entering the area in the near future provides a further need for all available barriers to be erected against the diseases and new bridges constructed to better health practices. Traditional teaching among the Huli emphasized the polluting effects of sexual contact. Missionary activity and the increasing commercialization of Huli culture have combined to weaken deterrents to premarital and extramarital sexual experiences. Traditionally, men believed that dangers of pollution came from two sources; women and outsiders. Only the Huli elders held these beliefs in the 1990s and little heed is paid to their warnings. Travel for work or pleasure has greatly increased among Huli men who no longer fear the outside world but rather wish to be part of it. Thus the traditional barriers which minimized infectious diseases have been demolished. The traditional Huli health-belief model is discussed and the possibility of harnessing traditional taboos in the fight against the spread of STDs is explored.     

Identifying the prevalence and correlates of STDs among women residing in rural domestic violence shelters

The present study uses a cross-sectional study design to assess the prevalence and abuse-related correlates of STDs among women (n = 203) residing in rural and nonurban domestic violence shelters, a venue in which health care providers could intervene by providing STD prevention counseling, diagnosis and treatment. To our knowledge, this is the first study to examine the prevalence and correlates of self-reported STDs among women residing in domestic violence shelters. In this sample, 99% of women reported being physically abused in the prior 2 months, 55% reported being sexually abused and 43% reported being raped. Further, 33% of women reported acquiring an STD during their abusive relationship, 13.3% reported acquiring multiple STDs and 9.2% reported acquiring an STD in the 2 months prior to entering the shelter. In this sample having a history of rape, having an unfaithful partner and fear negotiating condom use were all associated with having an STD history. Coordinating STD services with domestic violence shelters could reach a high-risk population that is not traditionally targeted by STD programs, could increase early detection of STDs, may increase access to and improve the quality of STD-related care, particularly among rural populations, and could be cost-effective.     

妇女性传播疾病研究现状。

该文综述了近年来妇女性传播疾病的发病状况及流行病学特征,其发病特点是性从业者为性传播疾病的高危群体。一般群体中,农村人口集中的西部地区性传播疾病的发病率呈上升趋势,农民工的流动性增大了西部农村妇女感染性传播疾病的几率。有些疾病则难以治愈,甚至产生耐药,如淋球菌的感染即属于此类。国外难治性淋球菌感染的报道资料较多,西欧地区12个国家首次淋球菌联合抗生素敏感性检测及德国、日本等国家和城市均有报道,但目前有的疾病甚至无治愈手段,如艾滋病。因此,研究者从阻断性传播疾病传播环节的预防方面提出设想并进行试验,并从生物、心理、社会三方面考虑出发,提出了妇女性传播疾病的综合防治干预思路。     

对收容教育所妇女口腔牙周、黏膜感染的调查

目的了解2001年深圳市收容教育所被收容教养的妇女性传播疾病(STDs)流行情况,以及高危人群的口腔牙周、黏膜感染状况。方法收集整理2001年被收容教养的妇女体检及实验室检测资料,并作流行病学分析,牙周疾病、口腔黏膜病感染状况检查,以世界卫生组织1987年公布的标准。结果302例收容教育所妇女中,共检出性病60例,检出率19.8%,牙龈炎的发病率57.4%,牙结石检出率25.8%,早期牙周疾病患病率4.96%;晚期牙周疾病患病率0.99%;口腔黏膜异常2.3%。结论收容教育所妇女是性病传播的主要传染源,提示口腔医务人员从职业角度需要采取有效措施,保护自身及患者的健康;加强医院感染的控制。     

Promising Practices in Preconception Care for Women at Risk for Poor Health and Pregnancy Outcomes

Objectives: Two programs targeting urban African-American women are presented as promising models for preconception care, which includes interconception care. Methods: The Grady Memorial Hospital Interpregnancy Care (IPC) Program in Atlanta, Georgia, and the Magnolia Project in Jacksonville, Florida, are described. The IPC program aims to investigate whether IPC can improve the health status, pregnancy planning and child spacing of women at risk of recurrent very low birthweight (VLBW). The Magnolia Project aims to reduce key risks in women of childbearing age, such as lack of family planning and repeat sexually transmitted diseases (STDs), through its case management activities. Results: Seven out of 21 women in the IPC were identified as having a previously unrecognized or poorly managed chronic disease. 21/21 women developed a reproductive plan for themselves, and none of the 21 women became pregnant within nine months following the birth of their VLBW baby. The Magnolia Project had a success rate of greater than 70% in resolving the key risks (lack of family planning, repeat STDs) among case management participants. The black to white infant mortality (IM) ratio was better for the babies born to women managed in the Magnolia Project compared to the same ration for the United States. Conclusions: Preconception care targeted to African-American women at risk for poor birth outcomes appears to be effective when specific risk factors are identified and interventions are appropriate. Outreach to women at risk and case management can be effective in optimizing the woman's health and subsequent reproductive health outcomes.     

Syndromic case management of STDs in Africa

Cost concerns as well as constraints of time, resources, and access to treatment frustrate and even impede the use of the etiological and clinical approaches to diagnosing and treating sexually transmitted diseases (STDs) in Africa. Syndromic case management, an alternative to these approaches, refers to the ability to identify and treat a syndrome caused by a STD, with minimal or no requirement for laboratory support. A syndrome can be defined as a combination of symptoms or complaints, with signs detected during clinical examination. The most important STD-related syndromes include urethral discharge in men, vaginal discharge in women, genital ulcer in men and women, lower abdominal pain, inguinal bubo (swelling), balanitis/balanoposthitis in men, and scrotal swelling. The aim of syndromic management is to identify a syndrome and treat it accordingly with combination therapy which will cover the main pathogens that cause it. The World Health Organization (WHO) strongly encourages the adoption of the syndromic management of STDs, and it has developed a series of flow-charts or clinical algorithms for the standardized management of STD cases. These general guidelines need to be adapted for local conditions in order to maximize their specificity and effectiveness. The advantages and disadvantages of syndromic case management, as well as the implementation of the strategy, are considered.     

Reproductive health care and family planning needs among incarcerated women

OBJECTIVES: Women in correctional institutions have substantial reproductive health problems, yet they are underserved in receipt of reproductive health care. We assessed the level of risk for sexually transmitted diseases (STDs) and the reproductive health needs of 484 incarcerated women in Rhode Island to plan an intervention for women returning to the community. METHODS: We used a 45-minute survey to assess medical histories, pregnancy and birth control use histories, current pregnancy intentions, substance use during the past 3 months, histories of childhood sexual abuse, and health attitudes and behaviors. RESULTS: Participants had extremely high risks for STDs and pregnancy, which was characterized by inconsistent birth control (66.5%) and condom use (80.4%), multiple partners (38%), and a high prevalence of unplanned pregnancies (83.6%) and STDs (49%). Only 15.4% said it was not likely that they would have sexual relations with a man within 6 months after release. CONCLUSION: Reproductive health services must be offered to incarcerated women. Such interventions will benefit the women, the criminal justice systems, and the communities to which the women will return.     

The role of training in STD prevention and control

The World Health Organization (WHO) estimates that 340 million new cases of curable sexually transmitted diseases (STDs) (excluding HIV and herpes simplex virus) occurred in 1995. The level of infection with STDs is especially troubling in developing countries, where they cause considerable morbidity. The consequences of infection with STDs can be personal, social, and economic. STD control programs are based upon the principles of primary and secondary prevention. Primary prevention strategies involve preventing the occurrence of new infections, while secondary prevention strategies aim to improve the management of STDs, and thereby to reduce their transmission and subsequent associated morbidity and mortality. Both primary and secondary prevention strategies require the dissemination of information from health workers to the at-risk population at a grassroots level, usually in primary health care centers. Health workers must therefore have a comprehensive and up-to-date knowledge of the many aspects of STDs, and be confident in their ability to communicate that information to others. A study in Tanzania determined that improvement in primary health care, including the provision of worker training, resulted in a 40% reduction in the incidence of HIV. The Wellcome Trust's new Topics in International Health series provides information on STDs on an interactive CD-ROM covering the epidemiology, diagnosis, clinical features, and treatment of the major STDs, except HIV, which is the subject of a separate CD-ROM. The CD-ROM was designed to be used in training programs for medical students and health care workers.     

Women's perceptions of health care in prison

Fifteen female inmates' perceptions of medical care and the manner in which treatment is provided are explored through individual interviews in a state prison. The women did not hold exclusively negative or positive views about the care and treatment they received; however, the predominant view was negative. Examples of inadequate medical care are described by 14 of the 15 women. Nonempathetic treatment, such as being treated as if undeserving of care, is described by all 15. Examples of adequate medical care and empathetic treatment are offered as well, and the overlap between positive and negative perceptions of care is explored.     

Sexually transmitted diseases in Morocco: gender influences on prevention and health care seeking behavior

Increased awareness of the medical and social costs of sexually transmitted diseases (STD) has resulted in greater attention to the control of these illnesses. STDs are responsible for a significant amount of morbidity in Morocco and have become a key target of the HIV control program. In 1996, the Ministry of Health conducted a qualitative study in order to enhance information, education and communication strategies in the national STD/HIV program. Data on the conceptualization and knowledge of STD, information sources and health-care-seeking behavior were gathered through 70 semidirected, in-depth interviews conducted with men and women in the general population and health care providers (HCPs). Two commonly applied health behavior theories in STD/HIV prevention, the Health Belief Model (HBM) and the Theory of Reasoned Action (TRA) served as a framework for data analysis. The most common name for STD is berd, which means "the cold" in Moroccan Arabic. Berd is caused either by cold striking the genital area or sexual intercourse and most often designates a syndrome of genital discharge. However, the term was also often used to indicate STD in general. The dual causality of berd maintains social stability by providing an honorable excuse for individuals who become infected, while warning against unsanctioned sexual behavior. Clear gender differences in understanding STDs and health-care-seeking behavior emerged through these interviews. STDs in Morocco are viewed as women's illnesses and men with STD often reported feeling victimized by women. Men appear to have more extensive informal information sources for STD than women. Consequences of STD, both physical and psychosocial, were viewed as more severe for women than men, and men had greater access to treatment, for both social and economic reasons.