Self-report of sexually transmitted infections from 1994 to 2010 by adults living in France

BackgroundSince 1994, French population-based knowledge, attitudes, beliefs and practices surveys have enabled researchers to estimate trends in sexual behavioural indicators.MethodsWe estimated trends and prevalence of self-reported sexually transmitted infections during the previous 5 years among 16,095 sexually active adults aged 18–54 through five cross-sectional telephone surveys between 1994 and 2010. We then studied the factors associated with participants’ most recent sexually transmitted infections other than genital candidiasis.ResultsOverall, 2.5% (95% confidence interval: 2.2%–2.9%) of women reported sexually transmitted infections within the previous 5 years, increases being continuously reported between 1998 and 2010. In contrast, men reported lower prevalence of sexually transmitted infections (1.4%; 95% confidence interval: 1.1%–1.7%), which remained stable over time. General practitioners and gynaecologists managed most sexually transmitted infections. Men notified their stable partners about infection less often than women (66% vs. 84%). Self-reported sexually transmitted infections were associated with younger age, multiple sexual partnerships and fear of sexually transmitted infections in both genders, with exclusively homosexual practices in men, and with a high educational level and recent HIV testing in women.ConclusionSelf-reported sexually transmitted infections clearly reflect risky sexual behaviours. The lower prevalence of self-reported sexually transmitted infections among men than among women may reflect less access to screening activities for sexually transmitted infections in men.     

Knowledge,Attitudes, and Beliefs Regarding HPV Vaccination: Ethnic and Cultural Differences Between African-American and Haitian Immigrant Women

BackgroundBlack women have higher rates of cervical cancer and lower rates of HPV vaccination than White women in the United States, and Haitians may be an especially vulnerable subgroup of Black women. To reduce these disparities, understanding differences among subgroups of Black women is crucial.MethodsThe objective of our study was to assess similarities and differences in the knowledge, attitudes, beliefs, and practices toward HPV vaccination and actual vaccination rates among African-American and Haitian immigrant women and their daughters. We used validated surveys of HPV knowledge, trust in physicians, acculturation, and constructs of the health belief model: Perceived susceptibility, severity, and barriers. We probed women's thought processes about vaccination using open-ended questions. We then reviewed medical records to determine vaccination rates.ResultsNineteen African Americans and 51 Haitians participated. Although 75% of Haitians and 63% of African Americans intended to vaccinate their daughters, only 47% of African-American and 31% of Haitian daughters were vaccinated. African Americans were more knowledgeable than Haitians and had more prior experience with HPV disease. Most African Americans felt that vaccination fell within the parental role, whereas many Haitians felt uncomfortable vaccinating against sexually transmitted infections because they felt children should not be having sex. Both ethnic groups wanted more information about HPV vaccines.ConclusionCultural differences between African-American and Haitian immigrant mothers revealed distinct barriers for vaccine acceptance. Improving HPV vaccine rates in Black women may require culturally competent and sensitive approaches that address ethnic-specific barriers.     

Reducing the risk of HIV transmission among adolescents in Zambia: Psychosocial and behavioral correlates of viewing a risk-reduction media campaign

PurposeThe purpose of this study was to evaluate phase I of a theoretically informed media campaign designed by youth in Zambia to encourage their peers to adopt risk-reduction practices to protect themselves from sexually transmitted infections and human immunodeficiency virus (HIV). The Helping Each other Act Responsibly Together (HEART) campaign conveys information for young people ages 13 to 19 years about sexually transmitted infections, HIV, and acquired immune deficiency syndrome transmission and prevention, and promotes abstinence, a return to abstinence, or consistent condom use as viable risk-reduction practices.MethodsSeparate sample baseline and follow-up designs were used to evaluate phase I of the HEART campaign among adolescents aged 13 to 19 years. The 1999 baseline survey had a sample of 368 male and 533 female adolescents; the 2000 follow-up survey comprised 496 male and 660 female adolescents.ResultsControlling for age, sex, educational attainment, and urban or rural residence, logistic regression analyses demonstrated that, compared with nonviewers, campaign viewers were 1.61 times more likely to report primary or secondary abstinence and 2.38 times more likely to have ever used a condom. The odds ratio of condom use during last sex was 2.1 for respondents who recalled at least 3 television spot advertisements compared with other respondents.ConclusionsThe positive correlations between HEART campaign viewership and HIV risk-reduction practices demonstrate that mediated messages can influence adolescents. The HEART campaign is among a range of programs in Zambia designed to enable young people to protect their reproductive health. Future research should capture the independent as well as the synergistic effects of multiple campaigns and interventions.     

Early Sexual Risk Among Black and Minority Ethnicity Teenagers: A Mixed Methods Study

PurposeTo determine how ethnic background influences early sexual activity among young adults.MethodsQuantitative data were collected during the Research with East London Adolescents Community Health Survey study, a population-based survey of young adults belonging to white and black and minority ethnic groups and residing in east London in 2001 (n = 2,689) and 2003 (n = 2,675). Qualitative data were obtained from 146 young adults between January and September 2003.ResultsBlack Caribbean, black African, white other, and mixed ethnicity young men were most likely to report high-risk sexual behaviors, that is, sexual debut at the age of ≤13 years, having unprotected sex, and having multiple sexual partners. There were marked variations within groups commonly collapsed as “black” or as “Muslim.” Black Caribbean and black African young adults reported high rates of protective behaviors in addition to risk behaviors. Qualitative data confirmed variations in sexual behavior within ethnic groups. Longitudinally, risk of engaging in two or more high-risk sexual behaviors was predicted by low family support (OR: 2.8, 95% CI: 1.6–4.9), regular smoking (OR: 4.5, 95% CI: 1.7–12.0), and usage of illicit drugs (OR: 2.9, 95% CI: 1.5–5.8), with lower risk predicted by low peer support (OR: .3, 95% CI: .2–.6).ConclusionsYoung adults belonging to black and minority ethnic groups reported a wide variation in sexual risk behaviors. High levels of high-risk behaviors were reported in ethnic groups known to have high rates of sexually transmitted infections. Effective sexual health interventions should be started early and they must focus on sexual debut and partner choices as well as messages regarding safe sex.     

Safe Sext: Adolescents' Use of Technology to Communicate About Sexual Health With Dating Partners

PurposeThis study examined adolescents' technology-based sexual communication with dating partners, and evaluated associations between technology-based communication and condom use.MethodsParticipants were 176 high school students who indicated their use of technology to communicate with partners about condoms, birth control, sexually transmitted infections (STIs), HIV/AIDS, pregnancy, and sexual limits. Sexually active youth also reported their frequency of condom use.ResultsMany adolescents (49%) used technology to discuss sexual health with partners, with rates varying by topic. Girls were more likely than boys to discuss HIV, pregnancy, and sexual limits. Ethnic minorities were more likely than whites to discuss condoms, STIs, HIV, pregnancy, and birth control. Importantly, rates of consistent condom use were three times higher among youth using technology to discuss condoms and birth control.ConclusionsResults provide novel preliminary evidence regarding adolescents' use of technology to discuss sexual health and demonstrate links between technology-based communication and condom use among sexually active youth.     

Disparities in Sexually Transmitted Infection/HIV Testing,Contraception, and Emergency Contraception Care Among Adolescent Sexual Minority Women Who Are Racial/Ethnic Minorities

PurposeSexual minority women and racial/ethnic minority women in the United States are at increased risk for sexually transmitted infections (STIs) and unintended pregnancy. Yet, we know little about STI/HIV testing and contraceptive care among women who have sex with women only and women who have sex with both women and men, and who are racial/ethnic minorities. This study examined receipt of STI/HIV testing and contraceptive care among sexually active adolescent women by sex of sexual contact(s) and race/ethnicity.MethodsOur sample included 2,149 sexually active adolescent women from the National Survey of Family Growth (2011–2019). We examined receipt of sexual and reproductive health (SRH) services by sex of sexual contact(s) and race/ethnicity: STI and HIV testing, contraceptive counseling, contraceptive method, emergency contraception (EC) counseling, and EC method.ResultsService receipt was low for all adolescent women, with disparities by sex of sexual contact(s) and by race/ethnicity. Women who have sex with women only had the lowest rates across all services; women who have sex with both women and men had higher rates of STI and HIV testing and EC counseling than women who have sex with men only. Non-Hispanic Black women had higher rates of STI and HIV testing than non-Hispanic White peers, and non-Hispanic Black and Hispanic women had lower rates of contraception method receipt than their non-Hispanic White peers. Racial/ethnic disparities persisted when results were stratified by sex of sexual contact(s).DiscussionThere is an unmet need for improved SRH service delivery for all adolescent women and for services that are not biased by sex of sexual contact(s) and race/ethnicity.     

Social disparities in women's health service use in the United States: a population-based analysis

PurposePoor and disparate reproductive health outcomes in the United States may be related to inadequate and differential receipt of women's health care. We investigated trends in and determinants of adult U.S. women's health service use, 2006–2010.MethodsWe analyzed population data from 7897 women aged 25–44 years in the National Survey of Family Growth from 2006 to 2010 using multivariable logistic regression.ResultsWomen's health service use in the past year was reported by 74% of the sample. Among noninfertile, sexually active women, 47% used contraceptive services; fewer used pregnancy (21%) and sexually transmitted infection (14%) services. In multivariable models, the odds of service use were greater among older, poor, unemployed women and women with less educational attainment than younger and socioeconomically advantaged women. Black women had greater odds of using pregnancy, sexually transmitted infection and gynecologic examination services than white women (odds ratio, 1.4–1.6). Lack of insurance was associated with service use in all models (odds ratio, 0.4–0.8).ConclusionsAlthough age-related differences in women's health service use may reflect fertility transitions, social disparities mirror reproductive inequalities among U.S. women. Research on women's health service use and outcomes across the reproductive life course and forthcoming sociopolitical climates is needed.     

COVID-19 Recession: Young Adult Food Insecurity,Racial Disparities,and Correlates

PurposeThe COVID-19 pandemic has inflicted devastating health, social, and economic effects globally. This study examines the experiences of young adults in the United States with respect to food insecurity during the pandemic and factors associated with higher and lower risk for young adult food insecurity.MethodsUsing the U.S. Census Bureau's Household Pulse Survey, a nationally representative survey collecting information on people's experiences throughout the pandemic, we analyzed prevalence of, and factors associated with young adult food insecurity during the pandemic.ResultsOverall, 13% of young adults aged 18–25 years reported often or sometimes not having enough to eat in the last 7 days at a given time during pandemic, on average, with Black and Hispanic young people facing higher rates of food insecurity (22% and 15%, respectively) than White non-Hispanic peers (11%). Over the observed pandemic period, we find a decline in food insecurity among young adults corresponding with economic policy actions. Factors associated with a higher risk of food insecurity include lower household income, expected job loss, renting as opposed to owning housing, behind on rent or mortgage payment, lack of confidence in an ability to pay next month's rent or mortgage, delayed medical care, and feeling worried or depressed.DiscussionOur analyses reveal alarming levels of food insecurity among young adults, especially Black and Hispanic young people. Policy actions should include multifaceted and sustained interventions with a focus on supporting historically disenfranchised youth and their communities. These should prevent and address food and housing insecurity and mental health needs holistically.     

Risk factors for sexually transmitted infections in adolescents

The prevalence of sexually transmitted infections (STI) among young people in Russia is examined for the recent decade. Risk factors and organization of STI patients detection, the knowledge of young people about STI are analyzed. Approaches to prevention of these diseases in the society are outlined.     

Are LARC Users Less Likely to Use Condoms? An Analysis of U.S. Women Initiating LARC in 2008–2018

IntroductionPublic health professionals have raised concern that increased use of long-acting reversible contraceptives (LARC) could raise women's risk for sexually transmitted infections (STIs), because LARC's superior pregnancy protection may decrease women's motivation to use a barrier method for supplemental pregnancy prevention. This study uses population-based data to examine whether condom use is lower, particularly among young women who are at increased STI risk, after initiating LARC versus moderately effective methods.MethodsWith the 2011–2019 data files of the National Survey of Family Growth, we examine the percent of sexually active months with condom use in the year after LARC or moderately effective method initiation for a nationally representative sample of 2,018 women aged 15–44 years. Multinomial logistic models regressed condom use on method type and age group, as well as their interaction, while adjusting for key confounders.ResultsThe unadjusted likelihood of any condom use is substantially lower among women who initiated LARC versus moderately effective methods (12% vs. 37%), and this difference is greater among younger versus older women. After accounting for differences in women's reproductive and sociodemographic profiles, however, a statistically significant difference in condom use by method initiated remains only for those aged 20–34 years.ConclusionsCrude estimates suggest that condom use is lower after initiating LARC versus moderately effective methods, especially among young women. After accounting for the confounding effects of LARC users’ distinct profiles—particularly in terms of parity and teenage childbearing—the difference is decreased overall and no longer significant for adolescent women. Overall results indicate a need for new STI prevention strategies and policies that emphasize the importance of dual prevention for LARC users at risk of STIs.     

Barriers to STI testing among youth in a Canadian oil and gas community

Northeastern British Columbia, Canada, is undergoing in-migration of young people attracted by jobs in the oil/gas sectors. Chlamydia rates among youth ages 15-24 are increasing and exceed the provincial average by 22%. Testing for sexually transmitted infections (STIs) reduces the disease burden, contributing to prevention. We conducted ethnographic fieldwork, including interviews with 25 youth and 14 service providers, to document their perceptions regarding youth's access to STI testing. Five key barriers to access were identified: limited opportunities for access, geographic inaccessibility, local social norms, limited information, and negative interactions with providers. To address youths' needs, we recommend active STI prevention and testing service delivery models that incorporate a locally tailored public awareness campaign, outreach to oil/gas workers, condom distribution, expanded clinic hours and drop-in STI testing, specialized training for health care providers, and inter-sectoral partnerships between public health, non-profit organizations, and industry.     

A method for identifying persons at high risk for sexually transmitted infections: opportunity for targeting intervention.

OBJECTIVES. The purpose of this study was to develop a method to identify persons at high risk for acquiring new sexually transmitted infections. METHODS. Computerized medical records from sexually transmitted disease clinics in Dade County, Florida, were used to conduct a retrospective cohort study. For all patients who visited in 1987, risk factors were identified for returning to the clinics within a year with a new sexually transmitted infection. Predictor variables were derived from the index visit and any visits in the year prior to the index visit. Logistic regression was used to develop a model that was applied to all patients who attended in 1989. RESULTS. Of 24,439 patients attending in 1987, 18.5% returned within a year with a new infection. Return rates were highest for 15- to 19-year-old Black males (31.8%). The highest odds ratios for returning were a diagnosis or treatment for an infection in the previous year and a diagnosis or treatment for infection at the index visit. The patients predicted to be at highest risk had a 39% return rate. There were as many new infections among the 2893 patients at highest risk as there were among the 13,326 patients at lowest risk. CONCLUSIONS. We developed a model that identifies persons at very high risk for sexually transmitted infection. These persons should be targeted for intensive intervention to reduce their risk.     

Oral and anal sex practices among high school youth in Addis Ababa,Ethiopia

Background  

Understanding the full range of sexual behaviors of young people is crucial in developing appropriate interventions to prevent and control sexually transmitted infections including HIV. However, such information is meager in developing countries. The objective of this study was to describe oral and anal sex practices and identify associated factors among high school youth.     

Sex,contraception and contradiction among young Filipinas in Australia

Despite recognition of the risks of unplanned pregnancy and disease transmission, the use of contraceptives and/or prophylactics among young sexually active Filipinas in Australia is inconsistent. While this does not set them apart from Australian-born young people, sexual expression is influenced by cultural values of both the immigrant family and dominant community. Young migrant women experience particular barriers in discussing sex with their parents or other community members, because of their concern with family honour and shame and tensions related to differences in values between the host and origin cultures. Issues related to sex, contraception and the prevention of sexually transmitted diseases are rarely dealt with openly, and, as a result, young women rarely have access to practical advice about services and information.     

Sexual behaviour among truck drivers in Pakistan

This study examines the level of risk of acquiring sexually transmitted infections among truck drivers and their helpers in Pakistan. Quantitative, self-reported, sexual behaviour data were collected from 300 randomly selected long-distance truck drivers and their helpers. Qualitative information was gathered through conversations with drivers. The findings show that multiple sexual partnerships with men and women are common among truckers. Awareness of AIDS and knowledge of sexual transmission of HIV is high. However, most truckers do not believe that AIDS exists in Pakistan. Nor are they aware that condoms are an effective way of preventing HIV transmission. Knowledge of the risks associated with unprotected sex is low among truckers, who consider themselves invulnerable to sexually transmitted infections because of their self-perception of being moral persons. Campaigns to increase risk awareness should emphasize the importance of condom use as an STI/HIV prevention method. Interpersonal communication is likely to be important in convincing truckers that sexually transmitted infections can be prevented.     

Dual Use of Condoms With Other Contraceptive Methods Among Adolescents and Young Women in the United States

PurposeTo estimate the prevalence of and factors associated with dual method use (i.e., condom with hormonal contraception or an intrauterine device) among adolescents and young women in the United States.MethodsWe used 2006–2010 National Survey of Family Growth data from 2,093 unmarried females aged 15–24 years and at risk for unintended pregnancy. Using multivariable logistic regression, we estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to assess the associations between dual method use at last sex and sociodemographic, behavioral, reproductive history, and sexual behavior factors.ResultsAt last sex, 20.7% of adolescents and young women used dual methods, 34.4% used condoms alone, 29.1% used hormonal contraception or an intrauterine device alone, and 15.8% used another method or no method. Factors associated with decreased odds of dual method use versus dual method nonuse included having a previous pregnancy (aOR = .44, 95% CI .27–.69), not having health insurance coverage over the past 12 months (aOR = .41, 95% CI .19–.91), and having sex prior to age 16 (aOR = .49, 95% CI .30–.78).ConclusionsThe prevalence of dual method use is low among adolescents and young women. Adolescents and young women who may have a higher risk of pregnancy and sexually transmitted infections (e.g., those with a previous pregnancy) were less likely to use dual methods at last sex. Interventions are needed to increase the correct and consistent use of dual methods among adolescents and young women who may be at greater risk for unintended pregnancy and sexually transmitted infections.     

Chlamydia and Gonorrhea Prevalence and Treatment in Detained Youths: Strategies for Improvement

PurposeAdolescents and young adults have the highest prevalence of sexually transmitted infections (STIs), accounting for more than 50% of all reported infections. An especially high-risk group includes adolescents in juvenile or correctional facilities.MethodsThis retrospective analysis was conducted at the only juvenile detention facility in the State of Hawai'i from 2014 to 2017. Adolescents aged 12–17 years were offered STI screening and/or presumptive treatment at the time of medical evaluation.ResultsOf 2,208 adolescents offered voluntary testing, 461 males and 372 females agreed to be tested for Chlamydia trachomatis and Neisseria Gonorrhea. Acceptance did not vary by age; females chose testing more often than males (67.4% vs. 27.8%; p < .0001). Females were also more likely to accept presumptive treatment (22.8% vs. 8.8%; p < .0001). In tested youth, STIs were prevalent in 24% of females and 10% of males. Before leaving the detention facility, only half the STIs in females and only 39% of male STI infections had been treated.ConclusionsThere was a high prevalence of STIs in both males and females admitted to this juvenile detention facility, with fewer than half the documented infections being treated before discharge. This indicates a need for universal and timely testing to allow the treatment of those infected. If for whatever reason rapid testing cannot be obtained, presumptive treatment offers a pragmatic approach to treatment and infection control.     

Two steps forward and one step back? Australian secondary students’ sexual health knowledge and behaviors 1992–2002

PurposeTo report on changes in the sexual health knowledge and sexual and risk behaviors of year 10 and 12 Australian school students between 1992 and 2002.MethodsSurveys were administered at five yearly intervals to a total of 6781 students in 263 government secondary schools in all Australian states and territories.ResultsAnalysis of data from the three survey administrations shows high levels of knowledge concerning human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), but a small but consistent decline since 1992. Knowledge about sexually transmitted infections and hepatitis remains poor. In 2002, there was an increase in the number of students reporting ever having had sexual intercourse, and this was most pronounced for year 10 students. The number of young men in year 10 who reported having three or more partners had doubled since 1997 to 33%. More year 10 young women also reported having intercourse with three or more partners. Consistency of condom use has improved over time; however, 39% still report condom use only sometimes.ConclusionSchool-based sexual health education provides a critical basis for ensuring that young people begin to experience sex safely and with an appropriate knowledge base.     

HIV Risk Reduction in Rural African American Women Who Use Cocaine

ABSTRACT

Research has demonstrated associations between cocaine use and sexually transmitted infections (STIs), including Human Immunodeficiency Virus (HIV). More research has been conducted among the sub-population of women, with less focus on rural African American women. Investigation of the social context that influences rural African American women's behavior that places them at risk for STI/HIV has received limited attention. The results of one component of the comprehensive study presented here focused on perceived STI/HIV risk reduction strategies of U.S. southern rural African American women who used cocaine. This ethnographic study of 30 rural African American women using cocaine was conducted over four years. Respondents described HIV risk reduction strategies and their motives for using them. Condoms were used more with casual partners (80%) than primary partners (16%) and with partners who were less known, less trusted, young, or physically or sexually “dirty.” Condoms were also used to prevent pregnancy (60%) more than to prevent STI/HIV (40%). HIV testing patterns varied, as did the motives for seeking testing. The sexual behavior of the women in this study exposed them to increased risk of STI/HIV. Although many perceived that they were using sexual risk reduction strategies, these strategies were not scientifically sound risk reduction strategies. Consequently, their exposure to STI/HIV continued as they used ineffective strategies both in assessing partner risk and in implementing risk reduction behaviors.     

Validación de una escala de conocimiento sobre el VIH y otras infecciones de transmisión sexual en población adolescente

ObjectiveThe objective of this research is to determine the validity and reliability of a questionnaire designed to specifically assess the knowledge of HIV and other sexually transmitted infections in a Spanish adolescent population.DesignCross-sectional study for the validation of a questionnaire.LocationA total of 17 schools in five Spanish provinces.ParticipantsA total of 1,570 adolescent schoolchildren between 13 and 17 years old.InterventionA pool of 40 items relating to knowledge about HIV and other sexually transmitted infections was established. This pool was analyzed by an expert panel. It was then administered to a pilot group with the same demographic characteristics of the sample, to ensure comprehension.Main measurementItem analysis, internal consistency, test/retest and exploratory factorial analysis.ResultsA factor analysis was performed, in which five factors that explained 46% of the total variance were retained: general knowledge about HIV, condom as a protective method, routes of HIV transmission, the prevention of HIV, and other sexually transmitted infections. Reliability measures ranged from 0.66 to 0.88. The test-retest correlation was 0.59. There were gender differences in the knowledge of infections.ConclusionsThese factors have adequate internal consistency and acceptable test-retest correlation. Theoretically, these factors fit properly with the content of the items. The factors have a moderate relationship, indicating that a high degree of knowledge about an aspect, but not a guarantee of general knowledge. The availability of a questionnaire to assess knowledge of sexually transmitted infections is helpful to evaluate prevention programs.