Incarceration and Sexually Transmitted Infections: A Neighborhood Perspective

The social dynamics of some communities are affected by the loss of significant numbers of people to prison and by the release of others who encounter the challenge of coping with the negative effects of the incarceration experience. The effects on communities are evident, in part, in the high rates of sexually transmitted infections (STIs) in North Carolina (NC) counties that have a high rate of incarceration. In the present study, we examined whether the same associations can be observed at the census tract level in one urban city of NC. To identify the mechanisms by which incarceration can affect the transmission of STIs, we conducted ethnographic interviews with ex-offenders and people who lost a sexual partner to prison. We found that census tract rates of incarceration were consistently associated with gonorrhea rates in the subsequent year. An increase of the percentage of census tract person-time spent in prison from 2.0% to 2.5% corresponded to a gonorrhea rate increase of 7.1 cases per 100,000 person-years. The people interviewed spoke of sexual partnership changes including those left behind finding new partners, in part for help in making financial ends meet; men having sex with men for the first time in prison; and having multiple new partners upon reentry to the community. The statistical associations and stories of the effects of incarceration on sexual relationships provide additional evidence of unintended community health consequences of high rates of incarceration. Thomas, Levandowski, and Torrone are with the Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC, USA; Isler is with the Department of Health Behavior and Health Education, School of Public Health, University of North Carolina, Chapel Hill, NC, USA; Wilson is with the Department of Criminal Justice, North Carolina Central University, Durham, NC, USA; Thomas is with the Program in Public Health Ethics, University of North Carolina, Chapel Hill, NC, USA.     

3452例性服务工作者性传播感染调查分析

目的了解柳州市某收容教育所性服务工作者性传播感染(STI)情况。方法收集整理1998~2004年柳州市某监测点性服务工作者体检资料及实验室检测资料,并作流行病学分析。结果在3 452例性服务工作者中,共检出性病654例,检出率为18.94%。其中梅毒检出例数最多,尖锐湿疣、NGU、淋病等次之。结论性服务工作者性病检出率高,是性病传播的主要传染源,也是性病防治的重点人群,梅毒是当前该地区应重点监控的病种。     

2005-2008年博白县主要性病疫情资料分析

[目的]了解博白县性病流行特征,为制订性病防制规划提供参考。[方法]对博白县2005～2008年艾滋病、淋病、梅毒疫情资料进行分析。[结果]2005-2008年合计报告艾滋病病人53例,年均发病率为0．84／10万。检出H1V感染者97例;报告淋病335例,年均发病率为5．32／10万;报告梅毒1230例（其中Ⅰ期386例,Ⅱ期179例,Ⅲ期7例,隐性梅毒596例,胎传梅毒62例）,年均发病率为19．54／10万。3种性病发病率均呈逐年升高趋势。年均发病率,男性为28．72／10万,女性为22．15／10万（P〈0．01）。1618例性病病人中,20～49岁1017例,占62．86％;民工、农民1186例．占73．30％。[结论]博白县性病发病率呈上升趋势,青壮年、男性、农民（包括民工）是高发人群。     

Taking a Stand: On Teaching the Epidemiology of Sexually Transmitted Infections

Sexually transmitted infections affect over 15 million Americans per year. Teenagers and young adults are disproportionately affected by a sexually transmitted disease and the lack of protective resources to avoid exposure. Because many infections produce no immediate, visible, or indisposing outcomes, persons possessing an infection may be unaware of their infectious status, and, subsequently, may—quite unknowingly—pass the infectious agent on to others. The activity described in this paper demonstrates the epidemiological processes that contribute to infection. Participants learn how sexually transmitted infections (bacterial, viral, and ectoparasitic) can be transmitted within a sexual network from only one infected individual.     

全国各省3种主要性传播疾病发病率的聚类分析

目的利用层次聚类分析法,对我国各省区3种主要性传播疾病发病率进行综合评判分类。方法 借助SPSS 15.0对我国2008年31个省区市3种主要性病-艾滋病、淋病、梅毒的发病率资料进行Q型聚类分析,距离测量采用组间平均法。结果当各省区市性病发病情况聚为4类时,广西,上海和浙江,云南和河南,因其不同的性病高发特点,各聚为一类,其余省区市聚为一类,未出现单个或少数几个省区因疾病低发而单独聚为一类的情况。结论我国性病的发病存在明显的高发区,而低发区发病特点不明显,更接近一般发病水平。     

Patterns of Adolescent Sexual Behavior Predicting Young Adult Sexually Transmitted Infections: A Latent Class Analysis Approach

Archives of Sexual Behavior - Adolescent sexual behavior is multidimensional, yet most studies of the topic use variable-oriented methods that reduce behaviors to a single dimension. In this study,...     

北京市怀柔区2004-2007年性传播疾病的流行病学分析

目的分析北京市怀柔区2004-2007年性传播疾病（STD）的流行病学特点,为制定有效的防治对策提供科学依据。方法以2004-2007年8种法定报告STD疫情资料为依据,进行流行病学分析。结果4年监测8种STD中,除软下疳和性病性淋巴肉芽肿外,其余6种均有报告,累计报告812例,STD年均发病率为61.19／10万;STD发病率呈逐年下降态势,由2004年的59.93／10万下降至2007年的57.86／10万;病种顺位随年份有所变化,尘锐湿疣由2004、2005、2006年的第2位跃居为2007年的第1位,并且发病呈逐年上升的趋势,淋病发病呈逐年下降的趋势,发病率由2004、2005年度第1位下降到2006、2007年度第3位。梅毒发病呈快速增长的趋势;男性发病多于女性,男性发病呈下降趋势,女性发病呈上升趋势;文化程度构成,中学及以下文化程度者占发病总数的65.39％,已婚患者占74.14％;非婚性传播占57.14％,报告病例本市占92.12％。结论北京市怀柔区近年来STD发病呈逐年下降趋势,但尖锐湿疣和梅毒发病呈逐年快速增长的趋势,加强STD防病知识的普及,提倡安全性行为,是控制STD蔓延的有效措施,也是预防艾滋病病毒感染的有效措施。     

2009年深圳市南山区性病疫情分析

目的了解深圳市南山区2009年性病流行特征,为性病防治提供参考。方法用描述流行病学方法分析取自国家疾病监测信息系统的2009年南山区性病疫情数据。结果 2009年南山区共报告5种性病3 406例,较2008年(3 526例)下降3.40%,年报告发病率为344.42/10万。男女病例数之比为1∶0.64;淋病、梅毒和尖锐湿疣报告年发病率下降,生殖道沙眼衣原体感染报告年发病率上升。病例构成中,生殖道沙眼衣原体感染比例最高,其次为淋病,尖锐湿疣居第3。梅毒新发病例减少,隐性梅毒构成比增加;男性性病最常见淋病,女性性病最多见生殖道沙眼衣原体感染;20~39岁年龄段病例占总报告病例的78.16%;性病职业分布以劳务工最高。结论综合原因导致性病流行病谱逐渐变化,因此,要相应调整控制措施和优化资源配置,加强对梅毒和生殖道沙眼衣原体感染的防治工作。重点应关注男性劳务工群体、妇女和老年群体。     

长沙市星级宾馆女性性工作者性传播感染知识及影响因素调查

目的了解长沙市星级宾馆女性性工作者性传播感染(STIs)知识掌握现状及其影响因素,为更好的在性工作者中开展性传播感染相关的综合防治工作提供依据。方法采用两级等概率随机整群抽样方法抽取了长沙市芙蓉区两个星级宾馆作为研究现场,用自编问卷对女性性工作者样本进行面对面访谈,了解其社会人口学特征、STIs防治知识掌握情况。结果164名女性性工作者调查时的平均年龄为(22.0±3.1)岁;平均接受学校正规教育的年限为(10.4±1.8)年;从业时间中位数7个月;开始从业年龄中位数为21.0岁;初次性行为年龄中位数为18.0岁。STIs防治知识条目总分为25分,女性性工作者STIs相关知识平均得分为(15.1±3.6)分,影响女性性工作者知识掌握的因素为初次性行为年龄和开始从业年龄。结论女性性工作者对性传播感染,特别是症状相关认知有待提高。在开展STIs防治知识的健康教育时应更关注女性性工作者中开始从业年龄和初次性行为年龄小的亚人群。     

南昌市西湖区2009--2010年性病报告的流行病学分析

目的了解南昌市两湖区性病监测点报告的性病的流行病学特征,为制定防治对策提供科学依据。方法对2009--2010年性病疫情报告资料进行描述性流行病学分析。结果2009年性病报告病例数为619例,以梅毒、淋病为主,男女性别比为1．42：1;2010年性病报告病例数为610例,以梅毒、尖锐湿疣、淋病为主,男女性别比为0．89：1;总体略呈下降趋势,报告发病数以20～34岁及60岁以上年龄段为主,职业分布以家务及待业和工人为主。结论今后性病防治重点人群为20～40岁及60岁以上者,职业以流动人口及工人为主。防治措施以加强宣传性病防治知识及推广100％使用安全套为主。     

2000～2006年许昌市部分甲乙类血源及性传播疾病流行病学分析

[目的]了解许昌市甲乙类血源及性传播疾病发病情况及流行特征，为制定防控措施提供科学依据。[方法]运用描述流行病学方法对2000～2006年许昌市乙肝、丙肝、淋病、梅毒和艾滋病发病资料进行分析。[结果]2000～2006年累计发病27655例，发病率为90．54／10万。各年发病率分别为35．52／10万、43．93／10万、57．14／10万、56．30／10万、105．33／10万、158．54／10万、184．18／10万，不同年份间发病率差异有统计学意义（P〈0．01）。5种血源及性传播疾病中，乙肝占85．32％，淋病占8．88％，丙肝占3．66％，梅毒占1．15％，艾滋病占0．99％。年平均发病率鄢陵县最高，为208．66／10万；2月发病最低，占7．13％；男女性别比为1．59：1；农民占66．89％；15～44岁组占72．11％。[结论]许昌市5类血源及性传播疾病发病率较高，应加强其防治工作力度。     

妊娠期妇女中四种性病病原体感染情况分析

目的　了解妊娠期妇女中 4种性病病原体的感染情况。　方法　用聚合酶链反应 ( PCR)法对 1785例妊娠期妇女宫颈分泌物进行人乳头状瘤病毒 ( HPV)、沙眼衣原体 ( CT)、解脲脲原体 ( UU)和淋病奈瑟菌 ( NG)检测。　结果　妊娠期妇女 4种性病病原体总阳性率为 5 .77% ( 10 3 /1785 ) ,其中 HPV阳性率 ( 12 .2 4 % )最高 ,CT阳性率 ( 9.3 1% )和 UU阳性率 ( 8.0 0 % )次之 ,NG阳性率 ( 2 .69% )最低 ,4种病原体感染差异有非常显著性 ( P<0 .0 1)。　结论　孕妇中存在着不同程度 4种性病病原体感染     

An Agent Based Model for Simulating the Spread of Sexually Transmitted Infections

This work uses agent-based modelling (ABM) to simulate sexually transmitted infection (STIs) spread within a population of 1000 agents over a 10-year period, as a preliminary investigation of the suitability of ABM methodology to simulate STI spread. The work contrasts compartmentalized mathematical models that fail to account for individual agents, and ABMs commonly applied to simulate the spread of respiratory infections. The model was developed in C++ using the Boost 1.47.0 libraries for the normal distribution and OpenGL for visualization. Sixteen agent parameters interact individually and in combination to govern agent profiles and behaviours relative to infection probabilities. The simulation results provide qualitative comparisons of STI mitigation strategies, including the impact of condom use, promiscuity, the form of the friend network, and mandatory STI testing. Individual and population-wide impacts were explored, with individual risk being impacted much more dramatically by population-level behaviour changes as compared to individual behaviour changes.     

Multiple Abortions and Sexually Transmitted Infections Among Young Migrant Women Working in Entertainment Venues in China

We conducted a survey of 358 young migrant women working in entertainment venues in China to explore the prevalence of and factors associated with two indicators of sexual and reproductive health: (1) multiple abortions and (2) the dual risk of sexually transmitted infections (STI) and abortion history. One quarter (25.4 percent) of the women in this sample had multiple abortions during their lifetime and, of those with any abortion history, 18.3 percent had had an abortion outside of a regulated health clinic. One-third (33.0 percent) of the sample had had an STI during the past year, and approximately one-fourth (23.7 percent) of those women did not receive STI treatment in a public hospital. Approximately one-fourth (23.5 percent) of the sample reported both a history of abortion and an STI during the past year. Women with a history of multiple abortions had significantly lower income levels, were more likely to have sex with clients and with husbands, and tended more to use alcohol before sex. Women who experienced both abortion and STI risks were more likely to report having had unprotected sex, genitourinary tract infections symptoms, anxiety, illicit drug use, and suicidal ideation. Enhanced efforts are needed to improve reproductive and sexual health for female migrants in urban China, particularly those working in entertainment venues.     

Prevalence of HIV,Syphilis, and Other Sexually Transmitted Infections among MSM from Three Cities in Panama

Respondent-driven sampling (RDS) was used to conduct a biobehavioral survey among men who have sex with men (MSM) in three cities in the Republic of Panama. We estimated the prevalence of HIV, syphilis, and other sexually transmitted infections (STIs), sociodemographic characteristics, and sexual risk behaviors. Among 603 MSM recruited, RDS-adjusted seroprevalences (95 % confidence intervals) were: HIV—David 6.6 % (2.2–11.4 %), Panama 29.4 % (19.7–39.7 %), and Colon 32.6 % (18.0–47.8 %); active syphilis—David 16.0 % (8.9–24.2 %), Panama 24.7 % (16.7–32.9 %), Colon 31.6 % (14.8–47.5 %); resolved HBV infection—David 10.0 % (4.8–16.8 %), Panama 29.4 % (20.0–38.3 %), and Colon 40.6 % (21.9–54.4 %); herpes simplex virus type 2—David 38.4 % (27.9–48.9 %), Panama 62.6 % (52.8–71.0 %), and Colon 72.9 % (57.4–85.8 %). At least a third of MSM in each city self-identified as heterosexual or bisexual. HIV prevalence is concentrated among MSM. Preventive interventions should focus on increasing HIV and syphilis testing, and increasing promotion of condom awareness and use.     

Programs to Reduce Teen Pregnancy,Sexually Transmitted Infections,and Associated Sexual Risk Behaviors: A Systematic Review

PurposeThis systematic review provides a comprehensive, updated assessment of programs with evidence of effectiveness in reducing teen pregnancy, sexually transmitted infections (STIs), or associated sexual risk behaviors.MethodsThe review was conducted in four steps. First, multiple literature search strategies were used to identify relevant studies released from 1989 through January 2011. Second, identified studies were screened against prespecified eligibility criteria. Third, studies were assessed by teams of two trained reviewers for the quality and execution of their research designs. Fourth, for studies that passed the quality assessment, the review team extracted and analyzed information on the research design, study sample, evaluation setting, and program impacts.ResultsA total of 88 studies met the review criteria for study quality and were included in the data extraction and analysis. The studies examined a range of programs delivered in diverse settings. Most studies had mixed-gender and predominately African-American research samples (70% and 51%, respectively). Randomized controlled trials accounted for the large majority (87%) of included studies. Most studies (76%) included multiple follow-ups, with sample sizes ranging from 62 to 5,244. Analysis of the study impact findings identified 31 programs with evidence of effectiveness.ConclusionsResearch conducted since the late 1980s has identified more than two dozen teen pregnancy and STI prevention programs with evidence of effectiveness. Key strengths of this research are the large number of randomized controlled trials, the common use of multiple follow-up periods, and attention to a broad range of programs delivered in diverse settings. Two main gaps are a lack of replication studies and the need for more research on Latino youth and other high-risk populations. In addressing these gaps, researchers must overcome common limitations in study design, analysis, and reporting that have negatively affected prior research.     

Preferences for Sexually Transmitted Infection and Cancer Vaccines in the United States and in China

ObjectivesThis study assessed preferences for hypothetical vaccines for children in 2 large vaccine markets according to how the vaccine-preventable disease is transmitted via a discrete choice experiment.MethodsSurveys in China (N = 1350) and the United States (N = 1413) were conducted from April to May 2021. The discrete choice experiment included attributes of cost, age at vaccination, transmission mode of the vaccine-preventable disease, and whether the vaccine prevents cancer. Preference utilities were modeled in a Bayesian, multinomial logistic regression model, and respondents were grouped by vaccine preference classification through a latent class analysis.ResultsIndividuals favored vaccines against diseases with transmission modes other than sexual transmission (vaccine for sexually transmitted infection [STI] vs airborne disease, in the United States, odds ratio 0.71; 95% credible interval 0.64-0.78; in China, odds ratio 0.76; 95% credible interval 0.69-0.84). The latent class analysis revealed 6 classes: vaccine rejecters (19% in the United States and 8% in China), careful deciders (18% and 17%), preferring cancer vaccination (20% and 19%), preferring vaccinating children at older ages (10% and 11%), preferring vaccinating older ages, but indifferent about cancer vaccines (23% and 25%), and preferring vaccinating children at younger ages (10% and 19%). Vaccine rejection was higher with age in the United States versus more vaccine rejection among those at the age of 18 to 24 and ≥ 64 years in China.ConclusionThe public had strong preferences against giving their child an STI vaccine, and the class preferring a cancer vaccine was less accepting of an STI vaccine. Overall, this study points to the need for more education about how some STI vaccines could also prevent cancers.     

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.     

Strategies for Managing the Dual Risk of Sexually Transmitted Infections and Unintended Pregnancy Among Puerto Rican and African American Young Adults

Although young adults in the United States are at increased risk for sexually transmitted infections (STIs) and unintended pregnancy, they do not report high rates of dual-method use (condoms plus other contraception) for prevention. We used prospective qualitative data from 69 urban Puerto Rican and African American individuals aged 18 to 25 years to determine how they managed these risks in their heterosexual relationships during a 4- to 8-week period. Hormonal or long-acting contraceptive use, condoms, and withdrawal were the most common unintended pregnancy prevention strategies; condoms, STI testing, and perceived fidelity were dominant among STI prevention strategies. We need to shift the focus from dual-method use toward a broader concept of dual protection to be more responsive to young adults’ concerns, perceptions, and priorities.The dual burden of unintended pregnancy and sexually transmitted infections (STIs) among adolescents, young adults, and ethnic minority groups in the United States is well documented. In 2002, among women aged 20 to 24 years, 45% of pregnancies were mistimed or unwanted, with higher prevalence among African American and Hispanic women compared with White women (52.9% and 46.5%, respectively, vs 41%).1 Young people aged 25 years or younger are also at high risk for nearly all major STIs, and African American and Hispanic populations are at higher risk compared with White populations.2,3 For example, in 2009, the rate of HIV diagnosis was 144.7 per 100 000 for African American, 38.3 per 100 000 for Hispanic, and 11.2 per 100 000 for White young adults aged 20 to 24 years.4 These disparities have been a steady cause for concern within the STI and reproductive health fields.5,6The co-occurrence of unintended pregnancy and STIs has prompted a relatively new body of research and interventions to focus on dual protection, which generally refers to behaviors that protect from both outcomes simultaneously. Work on dual protection to date almost exclusively has focused on dual-method use or the concurrent use of a condom (male or female) for STI prevention and a hormonal or long-acting contraceptive for unintended pregnancy prevention.7 National surveillance on dual-method use at last sexual intercourse shows that it is increasing but still fairly low. For example, females aged 15 to 19 showed a positive trend in the reported use of condoms and a hormonal contraceptive method at last sexual intercourse: 8% in 1995, 20% in 2002, and 21% in 2006 to 2008.8 The latest available data (2002) for women aged 20 to 24 years showed that the prevalence of dual-method use was about half that for adolescents.9Studies on dual-method use are mostly quantitative, tend to analyze dual use at a single point in time (e.g., at last sexual intercourse), and vary in their samples and predictors of dual protection, with mixed results. For example, race/ethnicity was not associated with dual-method use in one study but was associated in different directions in others.10–12 Other researchers have found positive associations between dual-method use and having higher educational attainment, being younger, feeling more at risk for STIs, being strongly motivated to avoid pregnancy, communicating with partners or parents about condom use, having positive attitudes about condoms, having a history of condom use, and having more than 1 partner in the previous 12 months, among other correlates.10–17 Conceptually, the determinants of dual use are multifaceted, involving the various barriers and facilitators of hormonal or long-acting contraceptive and condom use, such as side effects, health knowledge, service access, and relationship context.13,18,19 Finally, interventions aimed at increasing dual-method use are few and have had modest results.10,20,21More research is needed on dual-method use because it is generally agreed to be the most effective way to prevent both outcomes among sexually active persons.22,23 However, focusing exclusively on dual-method use has important limitations. Cates and Steiner22 emphasized the need to modify each person’s dual-protection approach according to both epidemiological and individual characteristics. Berer7 called for an expanded definition of dual protection that moves beyond dual-method use to include other methods and approaches to risk reduction and prevention, such as abstinence, consistent condom use, and condom use plus emergency contraception. She encouraged the sexual health field to overcome the disciplinary divide between STI prevention and unintended pregnancy prevention and to be more creative in understanding and promoting dual protection.7We built on this work and examined how young adults manage the simultaneous risks of unintended pregnancy and STIs in their sexual relationships by looking at not only dual-method use (classic dual protection) but also other strategies and perceptions that they draw on to minimize or address the risks they face. We used prospective qualitative data from 69 sexually active Puerto Rican and African American young adults to create an expanded list of dual-protection approaches like those Berer proposed yet one based on what young adults actually reported doing and thinking over a 4- to 8-week period. Our goal was to help identify alternative ways to view, research, and ultimately promote dual protection in this high-risk population.