Minority women with sexually transmitted diseases: sexual abuse and risk for pelvic inflammatory disease

Mexican American and African American women (N = 617) with a sexually transmitted disease (STD) underwent a targeted physical exam and questioning regarding sexual abuse, current genitourinary symptomatology, and pelvic inflammatory disease (PID) risk behaviors to determine the relationship between sexual abuse and risk for PID. Sexually abused women (n = 194) reported higher PID risk behaviors, including earlier coitus, more sex partners, higher STD recurrence, and a tendency toward delayed health-seeking behavior. They also reported more severe genitourinary symptomatology, confirmed by physical exam, and presumptive diagnoses of PID. These characteristics identify sexually abused women at high risk for PID. Because of its considerable impact on risk for PID, assessment for sexual abuse is essential in clinical management of women with STD and for diagnosis of PID.     

Relationship of abuse and pelvic inflammatory disease risk behavior in minority adolescents

PURPOSE: Little is known about the relationship between minority adolescent's experiences of sexual or physical abuse and the pathology of gynecological symptoms that might have an impact on the diagnosis of sexually transmitted disease (STD) or risk for pelvic inflammatory disease (PID). The objective of this study was to determine the relationship of sexual or physical abuse to the pathology of genitourinary symptoms that impact diagnoses of STD and risk for PID among Mexican American and African American adolescent women with a current STD. METHODS: Mexican American and African American adolescent women (n = 373) with an STD underwent a targeted physical exam and questioning regarding sexual or physical abuse, current genitourinary symptomatology, and risk behaviors known to be associated with PID to determine the relationship of sexual or physical abuse to the pathology of genitourinary symptoms that impact diagnoses of STD and risk for PID. RESULTS: Bivariate comparisons found that abused adolescents (n = 232) reported more behaviors associated with increased risk for PID, including earlier coitus, more sex partners, higher STD recurrence, and delayed health-seeking behavior. Multivariate comparisons found that abused adolescents were more likely to report pathologic genitourinary symptomatology than those who were not abused. Clinicians reported more abnormal physical exams but did not make any more presumptive diagnoses of PID for abused than nonabused adolescents. CONCLUSIONS: Delayed treatment for PID dramatically worsens future fertility and chronic pelvic pain. These findings demonstrate that abused adolescent women are at high risk for PID. Because of its considerable impact on risk for PID, an assessment for abuse is essential in clinical management of adolescent women with STD and diagnosis of PID.     

Context of sexual risk behaviour among abused ethnic minority adolescent women

CHAMPION J.D. (2011) Context of sexual risk behaviour among abused ethnic minority adolescent women. International Nursing Review 58 , 61–67 Background: Evidence suggests that multiple influences on sexual behaviour of adolescents exist, ranging from relationships with significant others including sexual or physical abuse and childhood molestation to substances used prior to sex and environmental circumstances such as sex work. Purpose: This study aims to describe associations between childhood molestation and sexual risk behaviour. Method: African American and Mexican American adolescent women aged 14–18 years (n = 562) with sexually transmitted infection (STI) or abuse histories and enrolled in a randomized controlled trial of behavioural interventions were interviewed via self‐report concerning sexual risk behaviour, abuse and childhood molestation at study entry. Results: Sexual (59%), physical (77%) and psychological (82%) abuse and childhood molestation (25%) were self‐reported without differences by ethnicity. Adolescents reporting childhood molestation experienced more forms of sexual, physical and psychological abuse than others and higher incidences of STI. Fewer attended school; however, more had arrests, convictions, incarcerations and probations. Stressors including depression, running away, thoughts of death and suicide were highest for those reporting childhood molestation. Those reporting childhood molestation engaged in higher sexual risk behaviours than adolescents experiencing other forms of sexual or physical abuse (lifetime partners, bisexual relationships, anal and group sex, sex with friends with benefits, sex for money, concurrent partners, drug use including multiple substances, alcohol use and alcohol problems). These adolescents reported ‘getting high’ and having sex when out of control as reasons for sex with multiple partners. Conclusion: Interventions for abused adolescent women necessitate a focus on associations between childhood molestation and a multiplicity of sexual risk behaviours for prevention of abuse, substance use and sex work, STI/human immunodeficiency virus (HIV) and sequelae.     

Drug use and HIV risk--related sex behaviors: a street outreach study of black adults

BACKGROUND: Our street outreach project investigated the relationship between use of noninjecting drugs (alcohol, marijuana, cocaine) and human immunodeficiency virus (HIV) risk-related sex behaviors of black adults. The study focused on three HIV-related risks: multiple sex partners, unprotected sex, and drugs during sex. METHODS: Data for this study were collected in a street outreach community survey for a drug abuse and HIV intervention study in Birmingham, Ala. A total of 780 black men and women completed the survey. RESULTS: High-risk sex behaviors were far more prevalent among cocaine users than marijuana or alcohol users. A greater number of cocaine users reported having multiple sex partners, not using condoms, and using drugs during sex. Female cocaine users showed the same risk level for HIV infection as male cocaine users. CONCLUSIONS: Increased risk of HIV infection through sexual transmission is associated with use of noninjecting cocaine for both men and women. Condom use should be considered as a major component of HIV prevention programs.     

Abused women and risk for pelvic inflammatory disease

Mexican and African American women with sexually transmitted diseases (STDs) underwent targeted physical exams and questioning regarding sexual or physical abuse, current genitourinary symptomatology, and pelvic inflammatory disease (PID) risk behaviors to determine the relationship of sexual or physical abuse to the pathology of genitourinary symptoms affecting diagnoses of STDs and risk for PID. Bivariate comparisons found abused women reported more PID risk behaviors including earlier coitus, more sex partners, higher STD recurrence, and delayed health-seeking behavior. Multivariate comparisons found abused women were more likely to report pathologic genitourinary symptomatology than nonabused women. Clinicians made more presumptive diagnoses of PID for abused than for nonabused women upon physical examination. These findings indicate abused women are at high risk for PID. Its considerable impact on genitourinary symptomatology and risk for PID make assessment for abuse essential in clinical management of women with STDs and diagnosis of PID.     

Minority adolescent women with sexually transmitted diseases and a history of sexual or physical abuse

Life history methods were used to obtain a more in-depth understanding of the configuration of psychosocial and situational factors that are associated with high-risk sexual behavior among minority adolescent women with a history of sexual or physical abuse and sexually transmitted disease (STD), to facilitate development of behavioral risk-reduction interventions. Study participants ranged in age from 14 to 18 years; 19 were Mexican American and 11 were African American. Women were recruited from clinics in a metropolitan health district. Various constitutive patterns unfolded during interview analysis including "fearing," "trusting," and "being a woman." The study revealed the perceptions of an extremely high-risk population of adolescent women regarding their STD risk, the context of their sexual relationships, sexual risk behaviors, contraception, and STD prevention, screening, and treatment practices. Intervention strategies based upon these findings are described.     

MINORITY ADOLESCENT WOMEN WITH SEXUALLY TRANSMITTED DISEASES AND A HISTORY OF SEXUAL OR PHYSICAL ABUSE

Life history methods were used to obtain a more in-depth understanding of the configuration of psychosocial and situational factors that are associated with high-risk sexual behavior among minority adolescent women with a history of sexual or physical abuse and sexually transmitted disease (STD), to facilitate development of behavioral risk-reduction interventions. Study participants ranged in age from 14 to 18 years; 19 were Mexican American and 11 were African American. Women were recruited from clinics in a metropolitan health district. Various constitutive patterns unfolded during interview analysis including “fearing,” “trusting,” and “being a woman.” The study revealed the perceptions of an extremely high-risk population of adolescent women regarding their STD risk, the context of their sexual relationships, sexual risk behaviors, contraception, and STD prevention, screening, and treatment practices. Intervention strategies based upon these findings are described.     

The lives of incarcerated women: violence, substance abuse, and at risk for HIV.

High rates of human immunodeficiency virus (HIV) infection and sexually transmitted diseases (STDs) are seen in women prisoners. These high rates may be related to the nature of their lives, which may include violence, substance abuse, promiscuity, prostitution, and exchange of sex for drugs--all of which increase their risk for acquiring HIV. The purpose of this study was to examine the HIV-related risk behaviors and protective practices of women prisoners in a rural southern state and factors related to these behaviors. The sample included 57 women incarcerated in a medium-to-maximum security prison. Key findings included high rates of substance abuse, extensive past and current violent experiences including sexual abuse, high percentage of multiple partners, and low use of condoms. Additionally, women in this sample did not perceive themselves to be at risk for HIV infection. Practical suggestions for reducing the HIV risks of incarcerated women are offered.     

The interrelationship between violence, HIV/AIDS, and drug use in incarcerated women.

The purpose of this study was to examine how violence co-occurs with drug use and HIV/AIDS high-risk behaviors among women incarcerated for drug use. This study was a supplement to a larger, experimental study designed to reduce HIV/AIDS high-risk behaviors among incarcerated female drug users. The women who participated (N = 170) reported that violence was a major part of their lives and affected many of their behaviors. Among these 170 women, 26.6% used condoms for oral sex, 46.4% for vaginal intercourse, and 65% were either sexually or physically abused. Intimate partner abuse was reported by 33.9% of the women. About 16% reported forced sexual activity, and 17.5% feared their partners. Women who refused to give oral sex to their male partners and those who insisted on condom use during oral sex prior to jail were more likely to be sexually or physically abused (chi 2 = 4.104; chi 2 = 3.886, p < .05, respectively). Although statistically significant interrelationships were not found among the three variables, significant bivariate relationships were found between intimate violence and HIV/AIDS high-risk behaviors.     

舟山海岛地区卖淫妇女HIV感染情况调查分析

目的　了解卖淫妇女的性行为特征及HIV感染情况 ,以便实施对STD/AIDS的综合监测有效的干预措施。方法　对舟山市收容所 113例卖淫妇女 ,采用统一表格匿名填写调查方法进行问卷。性交易地点 ,首次性交 ,开始卖淫年龄 ,年限 ,接待嫖客人数 ,安全套使用 ,同时采集静脉血 3ml作HIV抗体检测。结果　调查人群中年龄最小 17岁 ,主要在宾馆、美容美发店及租房等服务场所进行卖淫 ,首次性交年龄 ,首次卖淫在 19岁以下 ,分别占 34.51%、17.7%。外省流动妇女占 86.73% (98/113)。卖淫年限最长 10年。每日接嫖客高达 20多个 ,从来不用安全套 15.93% (18/113)。检出HIV抗体阳性 1例。结论　卖淫人群不安全性行为传播HIV危险 ,加大该人群健康教育和干预措施的实施 ,阻止AIDS经性的传播。     

2014年成都市性病门诊男性就诊者艾滋病哨点监测结果分析

目的 了解2014年成都市性病门诊男性就诊者艾滋病的流行特征以及艾滋病与丙型病毒性肝炎(丙肝)、梅毒的感染情况,为制订相关的防控措施提供科学依据。 方法 对400例性病门诊男性就诊者进行问卷调查,同时采集静脉血进行艾滋病、梅毒和丙肝的血清学检测。 结果 400例男性就诊者中,艾滋病病毒、梅毒、丙肝抗体检出率分别为5.50%、16.00%、0.25%,其中艾滋病知识总知晓率为86.00%,而近1年内接受艾滋病相关干预服务仅11.18%。近3个月23.36%的调查对象与暗娼发生过性行为,35.08%的人与临时性伴发生过性行为,5.00%的人承认与同性发生过肛交性行为。 结论 性病门诊是艾滋病/性病患者的集中场所,性病门诊就诊者又存在着知识和高危行为的分离现象,因此需加强对性病门诊就诊者的监测及针对性的行为干预,减少艾滋病/性病的传播。     

Gender-specific profiles of self-reported adolescent HIV risk behaviors.

The purposes of this study were to (a) identify behaviors that put adolescents at risk for HIV infection by retrospectively comparing a cohort of HIV positive and negative young adults and (b) determine gender-specific high-risk profiles. HIV-positive (n = 61) and HIV-negative (n = 124) individuals from two midwestern cities completed a survey tool prepared by the investigators examining six areas of behavior and activity identified in the literature as high risk. Alcohol use, drug use, and gang-related behaviors were not associated with HIV status in these young adults. Early, frequent, and unprotected sex with large numbers of partners were the predictive risk factors for HIV-seropositive status. Gender profiles, however, differed. Whereas the female profile suggested that early and unprotected sex were the only reliable predictors, HIV-positive male subjects had larger numbers of partners, engaged in more risky sexual behaviors, were more likely to have experienced sexual abuse before and during adolescence, and were more likely to have used cocaine during their adolescence. Conclusions include the confirmation of a resurgence of HIV among young males having sex with males and confirmation of females as the largest growing group of HIV-positive young adults.     

2013年太原地区男男性行为人群行为特征和HIV/STI感染情况的调查

目的了解太原市男男性行为人群(mem who have sex with men,MSM)行为特征、艾滋病防治知识知晓率、艾滋病/梅毒/丙型病毒性肝炎(丙肝)感染状况及影响因素。方法 2013年3-8月对MSM人群进行问卷调查,了解其人口学特征、性行为及性经历、性伴类型及数量、艾滋病相关知识、接受行为干预等内容,采集血样进行HIV、梅毒及丙肝抗体检测。采用χ2检验和logistic回归模型对感染HIV的影响因素进行分析。结果 255名符合标准的MSM参加了调查,自认同性恋占54.12%,双性恋占43.14%;首个性伴是男性占70.98%、女性占29.02%;与同性发生性行为时主动、被动肛交都做占45.88%;有固定性伴占55.29%,无44.71%;近6个月发生性行为,同性占85.49%,同性商业性行为占5.96%,异性占21.57%,性伴中位数为2人(1~200人),寻求男性性伴网络占71.56%,与不同性伴安全套使用率低下。HIV感染率为18.90%、梅毒7.48%、丙肝0.72%、HIV与梅毒合并感染2.36%。知识知晓率为91.76%。Logistic回归多因素分析显示,HIV感染与以下因素有关联:年龄﹥25岁(OR=3.04,95%CI:1.52~6.08),在本地居住时间2年以上(OR=0.76,95%CI:0.62~0.94),有性病感染(OR=3.818,95%CI:1.11~15.02)。结论 MSM人群属于性活跃人群,拥有性伴类型复杂多样,高危行为发生率高,使HIV及性病在该人群中广泛传播,加大对该人群的干预力度,减低高危行为,提高安全套的使用率,降低HIV在MSM人群中的传播。     

Incidence and correlates of physical violence among HIV-infected women at risk for pregnancy in the southeastern United States.

To identify the incidence and correlates of physical and sexual violence among HIV-infected women at risk for pregnancy, a cross-sectional examination was conducted within a longitudinal study of reproductive decision making. Participants consisted of 275 HIV-infected women 17 to 49 years of age (mean = 30.1 years). Women were predominantly African American (87%) and single (82%), with annual incomes of $10,000 or less (66%). Overall, 68% of the women reported experiencing lifetime physical and/or sexual violence. Before becoming HIV infected, 65% of the women reported having been physically or sexually abused. After HIV diagnosis, 33% of the women reported experiencing physical or sexual abuse. Women reporting greater violence were more likely to disclose their HIV-seropositive status to their sex partner. Using logistic regression, greater intent to get pregnant (odds ratio [OR] = 0.933), decreased present life satisfaction (OR = 1.048), having three or more children (OR = 0.474), and history of drug use (OR = 0.794) significantly distinguished between women who reported physical and/or sexual violence and those who did not.     

Gay identity, interpersonal violence, and HIV risk behaviors: an empirical test of theoretical relationships among a probability-based sample of urban men who have sex with men.

The highest absolute number of new HIV infections and AIDS cases still occur among men who have sex with men (MSM). Numerous theoretical approaches have been used to understand HIV risk behaviors among MSM; however, no theoretical model examines sexual risk behaviors in the context of gay identity and interpersonal violence. Using a model testing predictive correlational design, the theoretical relationships between childhood sexual abuse, adverse early life experiences, gay identity, substance use, battering, aversive emotions, HIV alienation, cue-to-action triggers, and HIV risk behaviors were empirically tested using confirmatory factor analysis and structural equation modeling. The relationships between these constructs are complex, yet childhood sexual abuse and gay identity were found to be theoretically associated with HIV risk behaviors. Also of importance, battering victimization was identified as a key mediating variable between childhood sexual abuse, gay identity, and adverse early life experiences and HIV risk behaviors among urban MSM.     

Health risk behaviors and medical sequelae of childhood sexual abuse.

The relationship between childhood sexual abuse and subsequent health risk behaviors and medical problems was examined in 511 women who had used a family practice clinic in a rural midwestern community during a 2-year period (1988 and 1989). These women completed a questionnaire that assessed various health risk behaviors--smoking, drinking, drug abuse, number of sexual partners, and age at first intercourse--and a medical symptom checklist that assessed 38 medical problems related to major systems of body function, the somatization scale from the SCL-90, a screen for sexual abuse, and a brief measure of social support. The results indicated that sexually abused women, who represented 22.1% of the sample, reported significantly more medical problems, greater levels of somatization, and more health risk behaviors than did the nonabused women. More severe abuse (for example, penetration or multiple abusers) correlated with more severe problems. Extent of social support correlated inversely with the number of gynecologic problems reported in the sexually abused group. Fewer than 2% of the sexually abused women had discussed the abuse with a physician. To identify and assist victims of sexual abuse, physicians should become experienced with nonthreatening methods of eliciting such information when the medical history is obtained.