Sexual and drug risk behaviors among women who have sex with women

OBJECTIVES: We examined risk behaviors of female drug users, comparing those who reported recently having had sex with women (recent WSW), those who reported previously having had sex with women (former WSW), and those who reported never having had sex with women (never WSW). METHODS: We used data from the Risk Evaluation and Assessment of Community Health III Study. Adjusted odds for predictors of WSW status were determined via multinomial logistic regression analyses. RESULTS: Of the participants, 75% were never WSW, 12% were former WSW, and 13% were recent WSW. In comparison with never WSW status, significant predictors of recent WSW status were living away from one's parents as a child (adjusted odds ratio [OR]=3.05; 95% confidence interval [CI]=1.07, 8.67) and recently having been paid for sex by men (adjusted OR=4.02; 95% CI=1.67, 9.68). Also, recently having been paid for sex by men was a significant predictor of former WSW status as opposed to never WSW status (adjusted OR=3.97; 95% CI=1.65, 9.59). CONCLUSIONS: The recency with which they had sex with women is one of the facets influencing the risk profile of WSW. The diverse characteristics of the WSW population need to be incorporated into future studies and risk interventions targeting this group.     

Neuropsychological function is improved among opioid dependent adults who adhere to opiate agonist treatment with buprenorphine-naloxone: a preliminary study

Background

Among persons with opioid use disorder (OUD), neuropsychological dysfunction is associated with depression, and better neuropsychological function is associated with opioid abstinence. However, it is unknown whether depressive symptomatology or adherence to opiate agonist treatment are associated with neuropsychological change over time.

Methods

We recruited 20 buprenorphine/naloxone-treated adults with OUD (M Age?=?45.2 years [SD?=?8.1]; 25% female) to complete baseline and 6 month visits containing a neuropsychological test battery and self-reported measures of depressive symptomatology and medication adherence.

Results

Depressive symptomatology was not significantly related to neuropsychological change (p’s?>?.05). Greater adherence to buprenorphine/naloxone was associated with improvements in learning, memory, and global functioning (r’s?=?.52–60; p’s?<?.05).

Conclusions

Among OUD patients, greater adherence to buprenorphine/naloxone is associated with improved neuropsychological functioning over time. In contrast, depressive symptomatology is not associated with neuropsychological functioning over time. Supporting adherence to buprenorphine/naloxone may improve and/or preserve learning and memory functioning in individuals treated for OUD.

Trial registration

NCT01108679. Registered 21 April 2010.

     

Increased breast cancer risk among women who work predominantly at night

Irregular working hours, including working at night, have serious psychological and physiological effects. In a nationwide population-based case-control study, we investigated the breast cancer risk among 30- to 54-year-old Danish women who worked predominantly at night. Individual employment histories were reconstructed back to 1964 for each of 7035 women with breast cancer and their individually matched controls from the records of a nationwide pension scheme with compulsory membership. Odds ratios, including 5 years of induction time and adjusted for socio-economic status, age at the birth of first and last child and number of children, were estimated by conditional logistic regression analysis. The odds ratio for breast cancer among women who worked at night at least half of a year was 1.5 (95% confidence interval, 1.2 to 1.7), and there was a tendency to increasing odds ratio by increasing duration of nighttime employment.     

Risk of hepatitis C virus infection among young adult injection drug users who share injection equipment

Designing studies to examine hepatitis C virus (HCV) transmission via the shared use of drug injection paraphernalia other than syringes is difficult because of saturation levels of HCV infection in most samples of injection drug users (IDUs). The authors measured the incidence of HCV infection in a large cohort of young IDUs from Chicago, Illinois, and determined the risk of HCV seroconversion associated with specific forms of sharing injection paraphernalia. From 1997 to 1999, serum samples obtained from 702 IDUs aged 18-30 years were screened for HCV antibodies; prevalence was 27%. Seronegative participants were tested for HCV antibodies at baseline, at 6 months, and at 12 months. During 290 person-years of follow-up, 29 participants seroconverted (incidence: 10.0/100 person-years). The adjusted relative hazard of seroconversion, controlling for demographic and drug-use covariates, was highest for sharing "cookers" (relative hazard = 4.1, 95% confidence interval: 1.4, 11.8), followed by sharing cotton filters (relative hazard = 2.4, 95% confidence interval: 1.1, 5.0). Risks associated with syringe-sharing and sharing of rinse water were elevated but not significant. After adjustment for syringe-sharing, sharing cookers remained the strongest predictor of seroconversion (relative hazard = 3.5, 95% confidence interval: 1.3, 9.9). The authors conclude that sharing of injection equipment other than syringes may be an important cause of HCV transmission between IDUs.     

HIV risk-related sex behaviors among injection drug users,crack smokers,and injection drug users who smoke crack.

OBJECTIVES. This study was designed to assess and compare sex risk behaviors for human immunodeficiency virus (HIV) transmission of three drug user groups: injectors who do not smoke crack, crack smokers who do not inject, and injectors who also smoke crack. METHODS. Sexual risk behaviors for HIV were assessed among 246 drug users from Denver, Miami, and San Francisco. Respondents were classified into the three drug groups based on self-report and verified through urinalysis and physical inspection. RESULTS. An increased risk for HIV through sexual transmission was associated with crack cocaine use, particularly among those who also injected. Crack smoking injectors were more likely to report sex with an injector, exchanging sex for drugs and/or money, drug use before or during sex, and unprotected sexual intercourse. They also injected more than injectors only, smoked crack as often as smokers only, and reported higher overall frequencies of drug use. CONCLUSIONS. These findings, together with the higher rates of gonorrhea and syphilis reported by smokers and injectors/smokers, are indicators of the risk crack poses for the heterosexual transmission of HIV.     

General preferences for involvement in treatment decision making among European women with urinary incontinence

Current health care policies advocate patient participation in treatment decision making. Little evidence on possible differences between European women's preferences for involvement in this process exists. In this study we explore preferences for involvement in treatment decision making in 15 European countries in a sample of 9434 women seeking treatment for urinary incontinence in an outpatient setting. Their generally preferred role in treatment decisions was assessed using the Control Preferences Scale. Results show variations within and between countries in preferences for involvement in treatment decision making. The 'collaborative role' was the most preferred role in Austria, Belgium, Denmark, France, Germany, Ireland, Sweden, Switzerland, the Netherlands and the UK. In Greece, Portugal and Spain the 'passive role' was most preferred. Over a third of women in Denmark, Finland and Norway preferred an 'active role'. Multinominal regression analyses found that, after adjusting for case mix and factors previously associated with role preferences, country membership was strongly associated with role preferences, with women living in Southern European countries preferring a more passive role. Such clear differences are of interest in the current health care environment where active patient participation is being encouraged. Greater efforts need to be made to establish whether patient preferences are genuine or merely a learned response influenced by cultural attitudes and traditions so that a balance can be struck between assisting women to play a more active role in the treatment decision-making process without disregarding some women's genuine preferences to play a more passive role.     

新旧注射吸毒人群HIV传播因素研究

目的探讨和分析新旧注射吸毒者的人口学特征及HIV传播因素,为预防控制艾滋病流行提供科学依据。方法选取针具交换点和戒毒所新旧人群为研究对象,采用面对面问卷调查,问卷内容包括新旧人群的人口学特征、艾滋病相关知识、干预服务参号隋况、高危行为学特征及HIV传播影响因素。应用SPSS16．0软件进行统计分析。结果共调查474例注射吸毒者,其中新人群（注射吸毒≤5年）及旧人群（注射吸毒〉5年）分别为157例（33．1％）和317例（66．9％）。调查对象的HIV感染率为20．5％,HIV感染率与吸毒年限呈正相关趋势（_=0．83,P=0．004）,且在5年内的变化速率最快。多因素Logistic回归模型结果显示,在〈30岁的新人群中,男性、重复使用及共用针具是HIV传播的影响因素;在30～40岁的旧人群中,男性、知晓共用注射辅助材料的危害及共用针具是HIV传播的影响因素;在〉40岁的旧人群中,男性、文化程度初中及以上、参加过针具交换及共用针具是HIV传播的影响因素。结论加强对新旧人群的宣传教育力度,倡导针具交换、有套性交、扩大干预服务覆盖面,知而信、信而行,是预防控制HIV传播与流行的有效措施。     

Maintaining respectability and responsibility: gendered labor patterns among women injection drug users

Gender-related factors and the social and economic conditions that impact the lives and health of women injection drug users (IDUs) in Chicago are described. Although study participants are highly imaginative and resourceful in terms of income-generating self-sufficiency, they engage in a variety of behaviors that put them at risk of contracting infectious diseases such as HIV and hepatitis B and C viruses. We point out that labor inequalities experienced by women IDUs, together with the gender ideologies that support those inequalities, provide reduced opportunities to practice harm reduction and other health care options.     

Sex role ideology among women with anorexia nervosa and bulimia

Anorexia nervosa is a complex of physical, emotional, and behavioral changes occurring in individuals who starve themselves because of an aversion to weight gain. Bulimia involves episodic binge eating, combined with an awareness that the eating pattern is abnormal. Theorists suggest that individuals with anorexia nervosa can be seen as rejecting the traditional female role, while individuals with bulimia can be seen as overidentifying with the traditional female role. The validated Sex Role Ideology Scale by Kalin and Tilby was used to determine if anorexics did in fact have a feminist perspective on women's role in society, and if bulimics had a traditional perspective. Data from the two patient groups (anorexics and bulimics) were compared to those of a control group of university students, matched for sex and age. No significant differences were found on the Sex Role Ideology Scale.     

Incidence of HIV among injection drug users entering drug treatment programs in four US cities

We estimated seroincidence of human immunodeficiency virus (HIV) and prevalence of risk behaviors among injection drug users (IDUs) who accepted voluntary HIV testing on entry to drug treatment. Record-based incidence studies were conducted in 12 drug treatment programs in New York City (n = 890); Newark, New Jersey (n = 521); Seattle, Washington (n = 1,256); and Los Angeles, California (n = 733). Records of confidential HIV tests were abstracted for information on demographics, drug use, and HIV test results. More detailed data on risk behaviors were obtained by a standardized questionnaire. Although overall incidence rates were relatively low in this population (<1/100 person-years), there was a high prevalence of risk behaviors. Needle sharing was reported by more than one-third of the participants in each of the cities. HIV seroincidence rates were up to three-fold higher among younger ID Us. We found that HIV continued to be transmitted among ID Us who had received both drug treatment and HIV counseling and testing. HIV/AIDS (acquired immunodeficiency syndrome) prevention education should continue to be an important component of drug treatment.     

Health-related quality of life changes associated with buprenorphine treatment for opioid dependence

Background

Few studies have described improvement in health-related quality of life (HRQOL) associated with opioid dependence treatment with buprenorphine (ODT-B).

Objective

To evaluate HRQOL changes in domain scores, physical and mental component summaries, and health utilities (HUs) associated with ODT-B using the Short Form 36 (SF-36).

Methods

We assessed HRQOL changes in a substudy of a pharmacokinetic study that compared buprenorphine oral tablet and liquid dosage formulations over 16?weeks. Individuals, aged 18?C65?years, were screened for opioid dependence. They were excluded if they would not agree to birth control or had a serious medical condition. Subjects received psychosocial counseling and weekly group therapy. The SF-36 was administered upon enrollment and at 4-week intervals. We used the SF-6D to estimate HUs. We performed intention to treat (ITT) analyses based on the last observation available for each subject. Paired t tests of each domain and HU, limited to remaining patients at each 4-week interval, were also conducted.

Results

Of 96 subjects enrolled, cumulative dropouts over time resulted in 80, 69, 59, and 44 subjects remaining at 4, 8, 12, and 16?weeks. There were no significant differences in opioid-positive urines, dropout rates, or dosage changes between formulations. In the ITT analyses, HRQOL improvements over time were bodily pain (62.1 vs. 69.1, P?=?0.017), vitality (49.8 vs. 56.5, P?=?0.001), mental health (59.9 vs. 66.0, P?=?0.001), social function (66.4 vs. 74.7, P?=?0.001), role emotional (59.4 vs. 71.9, P?=?0.003), role physical (60.9 vs. 70.6, P?=?0.005), and mental component summary (41.9 vs. 45.4, P<0.001). HU scores also improved (0.674 vs. 0.715, P?=?0.001). Results from paired t tests, with only concurrently enrolled patients, showed similar improvements from baseline to 4, 8, 12, or 16?weeks.

Conclusion

Buprenorphine, accompanied with psychosocial counseling, was associated with improved HRQOL and HUs.     

Risks and prevention of sexually transmissible infections among women who have sex with women

Health care providers working with women who have sex with women (WSW) have been ill-informed about a range of sexual health issues for these women. Pertinent issues include sexual behaviours that carry risks of sexually transmissible infection (STI), prevention strategies for safer sex and understanding experiences of abuse. A relative silence continues in all of these areas within the mainstream medical literature, textbooks, research and policy documents, which perpetuates medical ignorance. There is evidence that the prevalence of STIs among WSW is at least as high as among heterosexual women, if not higher among some sub-groups. Risk factors include the sex and number of sexual partners, minimal use of protected sexual behaviours and low levels of knowledge of STI prevention among WSW. Importantly, marginalisation leading to poorer mental health and experiences of abuse can combine to influence risk taking including substance abuse and risky sexual behaviours. Safe-sex guidelines and the need to recognise the impact of sexual abuse are presented.     

女女性行为人群吸烟和饮酒现状调查

目的 了解山东省聊城市女女性行为人群(WSW)吸烟和饮酒情况。方法 于2015年3-8月在山东省聊城市,采取滚雪球方式招募调查对象,对其进行一对一面对面调查。结果 调查WSW 78人,年龄中位数24.0岁,未婚65.4%(51/78),高中及以上学历占89.7%(70/78)。WSW大部分通过吸烟、饮酒方式发泄和缓解压力。吸烟比例为74.4%(58/78),主要吸烟原因为解忧解闷和需要提神。饮酒比例达84.6%(66/78),>50%是与拉拉朋友、同性恋人和性伴一起饮酒。吸烟者同时饮酒者占69.2%(54/78)(χ²=12.52,P<0.01)。58名吸烟者中,84.5%的人受到家庭婚姻或社会舆论压力(χ²=3.892,P<0.05);66名饮酒者中,83.3%的人承受家庭婚姻或社会舆论的压力(χ²=4.808,P<0.05)。结论 WSW吸烟和饮酒比例较高,应采取针对性的健康干预,控制该人群对烟草和酒精的依赖。