Men who have sex with men in Southeastern Europe: Underground and at increased risk for HIV/STIs

This paper reports on research that aimed to identify risk factors and preventive behaviours for HIV/STIs among men who have sex with men in Bulgaria, Kosovo, Macedonia and Romania. Twelve peer researchers conducted interviews on sexual behaviour, condom use and HIV/STI awareness. Data analysis revealed common themes across countries. Sexual activity takes place both in public spaces and private homes. Many men believe that careful partner selection and closing sexual networks to outsiders mitigate risk. Risk behaviours include unprotected sex within multiple partnerships, inconsistent condom use and the use of oil‐based lubricants that compromise the integrity of condoms. Perceived susceptibility for infection is low and misconceptions exist about modes of transmission. Stigma and discrimination force men into clandestine settings and relationships where safer sexual behaviour is difficult. HIV prevention programmes should convey messages through the internet and peer networks, improve access to condoms and water‐based lubricant, raise awareness about STIs, link men who have sex with men to appropriate services and reduce stigma to enable safer behaviour.     

Men who have sex with men in Southeastern Europe: Underground and at increased risk for HIV/STIs

This paper reports on research that aimed to identify risk factors and preventive behaviours for HIV/STIs among men who have sex with men in Bulgaria, Kosovo, Macedonia and Romania. Twelve peer researchers conducted interviews on sexual behaviour, condom use and HIV/STI awareness. Data analysis revealed common themes across countries. Sexual activity takes place both in public spaces and private homes. Many men believe that careful partner selection and closing sexual networks to outsiders mitigate risk. Risk behaviours include unprotected sex within multiple partnerships, inconsistent condom use and the use of oil-based lubricants that compromise the integrity of condoms. Perceived susceptibility for infection is low and misconceptions exist about modes of transmission. Stigma and discrimination force men into clandestine settings and relationships where safer sexual behaviour is difficult. HIV prevention programmes should convey messages through the internet and peer networks, improve access to condoms and water-based lubricant, raise awareness about STIs, link men who have sex with men to appropriate services and reduce stigma to enable safer behaviour.     

女性吸毒者HIV/STI相关高危性行为与HIV的传播关系

性途径感染HIV是世界范围内传播HIV的主要途径,也是目前中国HIV感染的主要方式[1].虽然近年经吸毒途径感染HIV的病例所占比例出现下降趋势,但吸毒人群至今仍是我国艾滋病防治的重要人群之一.虽然女性吸毒者仅占我国吸毒总人数的20.0%,在深圳等沿海地区约占40.0%[2,3],但其总数及所占比例近年都呈快速增长的趋势[4].另外,与男性吸毒者相比,女性具有特殊的吸毒行为及特征;女性吸毒者中有较高比例的卖淫行为(通过出卖性获取金钱或毒品),导致多性伴和无保护性行为等高危性行为特征,可加速HIV通过性途径继续传播的速度.     

Relationships between older men and younger women: implications for STIs/HIV in Kenya

The aim of this study is to contribute to the understanding of motivations for cross-generational relationships and how the perception of risk of acquiring sexually transmitted infections (STIs) including HIV affects condom use in Kenya. Eight focus-group discussions were conducted with women and 28 interviews were held with men in four Kenyan towns. Ethnograph 5.0 computer software was used for the analysis of data. Women's primary incentive for engaging in such relationships is financial; men seek sexual gratification. Pressure from peers compels women to find older partners. Although some peers encourage such relationships, other groups, especially wives, same-aged boyfriends, and parents, disapprove of them. Couples are preoccupied by the threat of discovery. STI/HIV risk perception is low, and couples rarely use condoms. Material gain, sexual gratification, emotional factors, and recognition from peers override concern for STI/ HIV risk. Women's ability to negotiate condom use is compromised by age and economic disparities. Programmatic strategies include communicating information about such relationships' STI/HIV risk, promoting consistent condom use, decreasing peer pressure to pursue such relationships, and improving women's access to alternative sources of income.     

云南省某矿区工人性行为和艾滋病病毒/性传播感染状况的调查

目的 了解云南省某地矿工艾滋病病毒/性传播感染（HIV/STIs）相关知识、态度、行为及其感染状况和影响因素.方法 2005年1月在云南省个旧市进行了由13名社区顾问委员会成员和12名矿工班组长参加的2个专题小组讨论;在个旧市2个矿区,用整群抽样方法招募矿工233名进行匿名问卷调查,并采血样进行HIV/STIs检测.结果 矿工艾滋病相关知识贫乏,三种传播途径的正确回答率为54.4%（92/169）,日常生活是否传播艾滋病的正确回答率为7.7%（13/169）.自我报告嫖娼的比例为9.0%.HIV和淋病感染率均为0.4%,衣原体感染率为8.2%.衣原体感染与文化程度（P=0.0347）和婚姻状况（P=0.032）有统计学联系.结论 矿工HIV/STIs预防意识差,安全套使用率低,是今后控制HIV的重点人群.     

HIV prevention at the grass roots level

In Washington, D.C. adolescents are infected with about 1/3 of all sexually transmitted diseases, and the incidence of congenital syphilis is mounting. The District of Columbia had a reported AIDS infection rate of 132.5/100,000 residents between July 1991 and June 1992 compared with 44.8 in New York. A total of 6613 cases were reported of which 6523 afflicted adults and adolescents. Only San Francisco had more cases with 12,402 cases of adults and adolescents reported. The District of Columbia's 1991 Youth Risk Behavior Survey disclosed that 78.8% of the 1275 adolescents in grades 9 and 10 had experienced sexual intercourse, and 38.8% of these were 13 years old or younger at 1st coitus. 33% of responders had had sex with 6 or more people. .53% of adolescent military recruits from the District had HIV infection, the highest rate in the nation. The District of Columbia Public Schools (DCPS) started an AIDS education program in 1987 for grades 4-12 with support from the Centers for Disease Control. During 1987-92 a 5-year HIV/AIDS Education program's activities involved formal training for all teachers; awareness seminars for school counselors and instructors; evaluation of teachers trained; student assessment of classroom training; DCPS Advisory Board with medical specialists, AIDS educators, and AIDS victims; coalition building with more than 20 organizations in the city; and distribution of literature to the 174 schools in the system. The program resulted in significant improvement in HIV/AIDS awareness at all 3 school levels, although it was more effective with elementary students and it made the least impact on senior high school students, especially on boys. Girls in junior high school showed improvement in knowledge, attitudes, and behavior concerning HIV/AIDS than boys. Future educational efforts should concentrate more on boys both in junior and senior high school.     

College graduation reduces vulnerability to STIs/HIV among African-American young adult women

African-American women are disproportionately affected by sexually transmitted infections (STIs), including HIV. The Theory of Gender and Power (TGP) posits that socioeconomic exposures, including educational attainment, place women at increased risk for STIs/HIV. This study examined the association between educational attainment and vulnerability to STIs/HIV, as well as potential TGP-driven mediators of this association, among African-American women. Baseline data were assessed from an STI/HIV prevention intervention for African-American women (n = 848) aged 18 to 29 recruited from three Kaiser Permanente Centers in Atlanta, Georgia. Data collection included a survey of demographic, psychosocial, and behavioral measures and self-collected, laboratory-confirmed vaginal swabs for STIs (trichomoniasis, chlamydia, gonorrhea, and human papillomavirus). Multiple regression analyses and multivariate mediation analyses were used to examine the association between educational attainment with a laboratory-confirmed STI and potential TGP mediators. Controlling for age and receipt of public assistance, the odds of an STI diagnosis were 73% lower among participants with a college degree or greater compared with participants who had not completed high school. There were also significant associations between educational attainment and multiple TGP mediators from the sexual division of power and the structure of cathexis. TGP constructs did not mediate the association between educational attainment and laboratory-confirmed STI. The current study suggests that graduating from college may lead to a beneficial reduction in vulnerability to STIs/HIV among African-American women. Findings from this study support expanding structural-level interventions, emphasizing both high school and college graduation, as a means of reducing vulnerability to STIs/HIV among African-American women.     

娱乐场所女服务员艾滋病性传播风险现况调查

目的了解卢湾区娱乐场所女服务员性传播感染和艾滋病感染（STIs／HIV）风险,为制定干预措施提供依据。方法随机抽取上海市卢湾区4家大型娱乐场所和18家小场所的125名女服务员进行问卷调查,并采集其血、尿标本进行实验室检测。结果HIV抗体阳性1人（0．8％）,梅毒RPR阳性12人（9．6％）。仅36．8％女服务员在最近3次性行为时使用安全套;超过50％的调查对象不知道怎样正确使用安全套。结论娱乐场所女服务员艾滋病、梅毒患病率高,艾滋病防治知识知晓率低,不安全性行为频繁,传播艾滋病风险高,应加强对该类人群的行为干预。     

Transactional Sex among Men and Women in the South at High Risk for HIV and Other STIs

Transactional sex refers to selling sex (exchanging sex for money, drugs, food, shelter, or other items) or purchasing sex (exchanging money, drugs, food, shelter, or other items for sex). These activities have been associated with a higher risk for HIV and other sexually transmitted infections in a variety of populations and settings. This paper examines correlates of purchasing and selling sex in a large sample of drug users, men who have sex with men, and sex partners of these groups. Using respondent-driven sampling, participants were recruited between 2005 and 2008 in two urban and two rural counties in North Carolina. We used multiple logistic regressions to examine separate models for selling and purchasing sex in men and women. In addition, we estimated direct and indirect associations among independent variables in the logistic regression models and transactional sex using structural equation models. The analysis shows that factors associated with women selling and buying sex include being homeless, use of stimulants, bisexual behavior, and neighborhood disorder. There was also a significant difference by race. For men, the factors associated with selling and buying sex include being homeless, bisexual behavior, and not being in a relationship. Although neighborhood violence and disorder show significance in bivariate associations with the outcome, these associations disappear in the structural equation models.     

HIV prevention and African American youth: examination of individual-level behaviour is not the only answer

African American youth continue to be disproportionately represented in the incidence and prevalence of HIV despite numerous prevention efforts that target adolescent populations and declines in sexual risk behaviour among youth in general during the last decade. Several studies examining individual-level behavioural factors have failed to explain the health disparity in HIV prevalence. African American youth experience higher rates of HIV and other STIs, even when their sexual behaviour is normative. These findings suggest the need to expand beyond the examination of individual-level factors and to consider contextual issues such as economic, geographic and cultural influences. This paper reviews the relationship between contextual factors and HIV risk and prevalence and the implication for prevention for African American youth.     

Prevention of Unintended Pregnancy and HIV/STIs Among Latinos in Rural Communities: Perspectives of Health Care Providers

Latino women in the United States are disproportionately at risk for unintended pregnancy, HIV, and sexually transmitted infections (STIs). We conducted nine focus groups with health care practitioners who provide reproductive health care to Latinos in rural areas of the Northwest. From the practitioner perspective, we explored barriers and facilitators to the acquisition and use of contraceptives and to the prevention of HIV/STIs among rural Latinos. Suggestions for improving reproductive health care included Spanish-language resources/materials and convenient contraceptive methods. Findings provide context to the complex issues related to unintended pregnancy and disease prevention among Latinos residing in rural communities.     

县级区域性艾滋病预防控制的策略与经验

云南省临沧县开展了艾滋病社区健康教育项目和艾滋病预防控制与关怀项目，对县级区域性艾滋病预防控制工作进行总结：1）以充分的组织领导为基础，强化艾滋病预防控制工作，将行政领导措施与具体业务工作有机结合：2）以大众宣教为基础，辅以社区关怀工作；3）营造一个良好的社会环境和氛围，突出“人性”，辅以必要的物质关怀和生活帮助；4）让HIV感染者主动参与艾滋病预防控制工作；5）学校对广大学生与青年开展健康教育。     

Risk perception and vulnerability to STIs and HIV/AIDS among immigrant Latin-American women in Canada

This paper describes the migratory experiences of Latin American migrant women living in Canada, their perceptions of the risk of HIV, AIDS and other sexually transmitted infections (STIs) and barriers to accessing healthcare services. We conducted 25 in-depth interviews with Latin American migrant women living in Montreal, Canada. The majority of participants were permanent residents and refugee status claimants. Women’s experiences in Canada were characterised by uncertainty, deception and fraud, separation from their families and feelings of discrimination. Women’s risk perception of HIV/AIDS/STIs involved relations of gender inequalities of power. Women who did not perceive themselves to be at risk were those who had a stable partner who they felt they could trust. The majority of women reported difficulties in accessing sexual and reproductive health services. Women’s vulnerability to HIV/AIDS/STIs was determined by: experiences during their lifecourse; their migratory status, which was associated with sexual abuse, abuse at work, language barriers and lack of social support networks; and their ability to access health services. The provision of health services to this population must focus on sexual and reproductive health needs and should do so from a multicultural perspective that takes into account the changes associated with the migration process.     

Epidemiology of STIs: UK

The epidemiology of STIs in the UK has undergone marked changes over the last century. After two major peaks in syphilis and gonorrhoea coinciding with the two World Wars, the incidence of these STIs decreased dramatically after World War II, with the advent of penicillin. The 1960s and 1970s saw a resurgence of gonorrhoea and syphilis, and the male:female ratio of reported syphilis cases increased, suggesting that transmission among men who have sex with men (MSM) was increasing. STI incidence again declined in the 1980s with the advent of the HIV/AIDS epidemic, suggesting that widespread changes in sexual risk behaviour patterns were occurring. These decreases were not sustained, however, and during the mid-to-late 1990s both viral and bacterial acute STIs increased substantially. This trend has been most marked in young people and MSM. Numbers of reported gonococcal infections more than doubled to between 1995 and 2003, to 24,157 cases in England, Wales and Northern Ireland; syphilis increased more than tenfold to 1580 cases as a consequence of localised outbreaks, particularly in MSM. Data from 2003 compared with 2002 indicate stabilization or slowing of some STIs, including gonorrhoea and genital herpes, numbers of which decreased by 4% and 3% respectively. Rates of genital warts, chlamydial infection and syphilis continued to increase. Delivery of appropriate, effective STI preventive interventions targeted to those at highest risk, including young people and MSM, continues to be a public health priority.     

Vulnerability to STIs/HIV: sociability and the life trajectories of young women who have sex with women in Rio de Janeiro

This study aims to better understand STI/HIV-related vulnerability among self-identified lesbians and bisexual young women aged 18–26 years in two neighbourhoods in Rio de Janeiro. Based on ethnographic observations and in-depth interviews, the paper analyses their life experiences and trajectories. Findings reveal that sexual identities and ties attributed to sexual interactions with women and men have an important role in influencing perceptions of vulnerability. The notion of STI and HIV risk is not well developed among women who have sex with women. It emerges largely in practices with bisexual female partners and those of the opposite sex, since in these the potential for HIV transmission (through contact with semen) is recognized. Sexually transmitted infection and HIV-related risk with male partners is seen as small by the women in the study, since such relationships are seen as ‘occasional’ and generally speaking occur with someone they know well. The value given to trust and the lack of alignment between sexual identities and sexual practices reinforces the need for approaches to STI and HIV prevention and care that prioritise the sexual history and practices of women and their sexual identities within specific contexts.