Understanding sex partner selection from the perspective of inner-city black adolescents

CONTEXT: Black adolescents in inner-city settings are at increased risk for HIV and other STDs. Sex partner characteristics, as well as individual behavior, influence individuals' STD risk, yet little is known about the process of sex partner selection for adolescents in this setting. METHODS: Semistructured in-depth interviews were conducted during the summer and fall of 2002 with 50 inner-city black adolescents (26 females and 24 males) who had been purposively recruited from an STD clinic. Content analysis was used to study interview texts. RESULTS: Young women desire a monogamous romantic partner, rather than a casual sex partner; however, to fulfill their desire for emotional intimacy, they often accept a relationship with a nonmonogamous partner. Young men seek both physical and emotional benefits from being in a relationship; having a partner helps them to feel wanted, and they gain social status among their peers when they have multiple partners. For men, these benefits may help compensate for an inability to obtain jobs that would improve their financial and, as a result, social status. Both women and men assess partners' STD risk on the basis of appearance. CONCLUSIONS: HIV and other STD prevention initiatives must go beyond the scope of traditional messages aimed at behavior change and address the need for social support and socioeconomic opportunities among at-risk, inner-city adolescents.     

Type, content, and source of social support perceived by women during pregnancy: evidence from Matlab, Bangladesh

Specific and contextualized data on social support during distinct health events are needed to improve social support interventions. This study identified the type, content, and source of social support perceived by women during pregnancy. In-depth interviews with 25 women, aged 18-49 years, living in Matlab, Bangladesh, were conducted. The findings demonstrated that women perceived, the receipt of eight distinct types of support. The four most frequently-mentioned types included: practical help with routine activities, information/advice, emotional support and assurance, as well as the provision of resources and material goods. Sources varied by type of support and most frequently included-mothers, mothers-in-law, sisters-in-law, and husbands. Examples depicting the content of each type of support revealed culturally-specific issues that can inform community-based social support interventions.     

Types and sources of social support among adults living with type 2 diabetes in rural communities in the Dominican Republic

Type 2 diabetes management hinges on various determinants, including the role of interpersonal relationships in self-management behaviours. The aim of this study was to explore the types and sources of social support received by adults in the diabetes diagnosis and self-management processes. We conducted qualitative interviews with 28 men and women at two rural clinics in the Dominican Republic and used a combination of narrative and thematic analytic techniques to identify key sources and types of social support in their diabetes experiences. Participants described three stages in their diabetes experience: diagnosis, programme-enrolment, and long-term management. During diabetes diagnosis, most participants described receiving no support. At the programme-enrolment stage, friends and neighbours frequently provided informational or instrumental support to get to the clinic. In long-term management, cohabiting partners provided the most support, which was often assistance with their diet. Our findings highlight he need to assess and leverage distinct types and sources of social support at different stages of the diabetes experience.     

Infrequency of sexually transmitted disease screening among sexually experienced U.S. female adolescents

CONTEXT: Since 1993, the Centers for Disease Control and Prevention and professional medical organizations have recommended that all sexually experienced female adolescents receive annual screening for Chlamydia trachomatis. Whether adolescents receive this care is largely unknown. METHODS: Reports of receipt of testing or treatment for a sexually transmitted disease (STD) in the past year, as well as sites of care, were obtained from 3,987 sexually experienced females in grades 7-12 who participated in Wave 1 of the National Longitudinal Study of Adolescent Health, conducted in 1995. Logistic regression was used to determine predictors of reporting care. RESULTS: Eighteen percent of all participants reported having received STD services in the past year. Of those who reported having had a routine physical examination in the past year, 22% reported receipt of STD services. The proportion reporting STD care increased linearly with age from 9% of 12-13-year-olds to 25% of those 19 or older. In adjusted analyses, the odds of reporting testing or treatment were elevated among participants who had had a physical examination in the past year (odds ratio, 2.1), those with Medicaid or Medicare insurance (1.9), black women (1.5) and older adolescents (1.2). Adolescents most often reported having received STD care at a community health center (44%) or a private physician's office (31%). CONCLUSIONS: Continued inadequate screening may contribute to persisting high prevalence of chlamydia infection among adolescents. Future research is needed to determine whether the proportions of adolescents receiving recommended STD screening have increased over time.     

Linking Clients from HIV Antibody Counseling and Testing to Prevention Services

The effectiveness of HIV antibody counseling and testing as a prevention intervention is limited: persons testing seronegative do not usually change their risk behaviors, some actually increase their risk behaviors, and decreases in risk behaviors are usually short-lived. Referrals to additional prevention and other needed services are therefore recommended, although the extent and determinants of referral provision for persons testing seronegative are unknown. We assessed the prevalence of referrals and the association between risk behaviors and prevention referrals among seronegatives. We reviewed HIV testing and referral data on all persons receiving confidential seronegative test results in San Francisco (SF) in the first 10 months of 1995 (n = 5,595), and gathered more detailed referral information at the municipal STD clinic from November 1995 through May 1996 (n = 747). The overall prevalence of referrals was low: a referral was given to 19.1% of the SF sample and 10.6% of the STD clinic sample; 15.4% of the SF sample and 5.9% of the STD clinic sample received a prevention referral. Injection drug users (IDUs) were the most likely to receive a prevention referral (48.5% of SF IDUs, 36.4% of STD clinic IDUs); men having sex with men and women with high-risk partners were also more likely to get a prevention referral than others. For SF IDUs, unsafe sex and needle sharing were not associated with an increased likelihood of receiving a prevention referral. Opportunities to link high-risk clients from counseling and testing to HIV prevention services are being missed. The referral component of HIV counseling and testing should be improved.     

Public or private providers? U.S. women's use of reproductive health services

CONTEXT: U.S. women receive contraceptive and reproductive health services from a wide range of publicly funded and private providers. Information on trends in and on patterns of service use can help policymakers and program planners assess the adequacy of current services and plan for future improvements. METHODS: Women who reported in the 1995 National Survey of Family Growth that they had obtained any contraceptive or other reproductive health service in the past year were classified by their primary source of care, and the services they received, their characteristics and their primary source of care were analyzed. Logistic regression was used to test which factors predict women's use of publicly subsidized family planning clinics and of specific types of services. RESULTS: The percentage of women of reproductive age who obtained family planning services increased slightly between 1988 and 1995, primarily among women aged 30 and older. Nearly one in four women who received any contraceptive care visited a publicly funded family planning clinic, as did one in three who received contraceptive counseling or sexually transmitted disease (STD) testing and treatment. Women whose primary source of reproductive care was a publicly funded family planning clinic received a wider range of services than women who visited private providers; moreover, the former were significantly more likely to report obtaining contraceptive care or STD-related care, even after the effects of their background characteristics were controlled. Young, unmarried, minority, less-educated and poor women were more likely than others to depend on publicly subsidized family planning clinics. Source of health insurance was one of the most important predictors of the use of public family planning clinics: Medicaid recipients and uninsured women were 3-4 times as likely as women with private insurance to obtain clinic care. CONCLUSIONS: Publicly funded family planning clinics are an important source of contraceptive and other reproductive health care, providing millions of U.S. women with a wide range of services. Since women's need for reproductive care and for publicly subsidized care is not likely to diminish, clinics may be financially challenged in their efforts to continue delivering this broad package of services to growing numbers of uninsured or disenfranchised women.     

Recovering from a heart attack: a qualitative study into lay experiences and the struggle to make lifestyle changes

BACKGROUND: The adoption of healthy living advice by people with heart disease is known to be poor even in targeted interventions. Reasons for this can range from confusion about the seriousness of the condition to ineffectiveness in the form of advice and how it is conveyed. However, the social setting can be an important influence on lifestyle change. OBJECTIVES: To identify views and experiences of people recovering from myocardial infarction, specifically barriers to, and facilitators of, following advice about lifestyle change and maintenance. METHODS: Focus groups and interviews were undertaken with men and women discharged from hospital two/three years previously. A total of 53 people (35 men and 18 women) took part, recruited via a coronary care unit and patients' GPs. RESULTS: A major finding was participants' desires for long-term monitoring and support. While reported sources, form and content of coronary heart disease advice varied, most participants agreed that long-term follow up or back-up would be helpful, although what this should include and how it should be undertaken was not the same for all participants. This would fulfil needs such as: help in following lifestyle advice; sharing with people with similar experiences; regular contact with medical/health professionals (for confirmation of good heath and to ask questions); providing reassurance to other members of the patients' families. CONCLUSIONS: A long-term programme is needed incorporating mutual support and sharing with regular (not necessarily frequent) input from practitioners of information, advice and reassurance, as a support strategy for lifestyle change.     

Gender differences in quality of HIV care in Ryan White CARE Act-funded clinics.

BACKGROUND: Women with HIV infection have lagged behind men in receipt of critical health care, but it is not known if those disparities are due in part to where women receive care. We examined differences in care received by HIV-infected women and men in a national sample of Ryan White CARE Act-funded clinics and explored the influence of clinic characteristics on care quality. METHODS: Record review was done on a sample of 9,015 patients who received care at 69 CARE Act-funded HIV primary care clinics that participated in a quality improvement study. Outcome measures studied were highly active antiretroviral therapy (HAART) use, HIV viral suppression, Pneumocystis jiroveci pneumonia (PCP) prophylaxis, screening, and other disease prevention efforts. RESULTS: Women were less likely than men to receive HAART (78% versus 82%, p < .001), receive PCP prophylaxis (65% versus 75%, p < .0001), or have their hepatitis C virus status known (87% versus 88%, p = .02) despite being seen more regularly (69% versus 66%, p = .04). Sites serving high percentages of women delivered similar or better care for both men and women than other sites. Although sites serving a higher percent of women had more support services such as case management and onsite obstetrician-gynecologists and provided Pap smears at higher rates, women at such sites remained less likely than men to receive important HIV care including HAART and PCP prophylaxis. CONCLUSIONS: The gap in the quality of care provided to HIV-infected men and women in critical areas persists, and is not explained by the types of sites where men and women receive care.     

Perceptions of social support for weight loss among patients in primary care

This study examined primary care patients’ experiences with support for weight loss efforts. Adult patients (N = 106) were recruited through primary care clinics and completed an electronic survey pertaining to their weight loss efforts. The majority (76%) received support from their existing social network (e.g., family members, professionals); 59% had used apps and <20% had used social media for support. Findings reveal differences in satisfaction with support between men and women and between support sources, which will be useful for informing weight loss interventions in primary care.     

Social Support Sources,Types, and Generativity: A Focus Group Study of Cancer Survivors and Their Caregivers

Various research studies have identified the sources and types of support that people with cancer receive; however, few have focused on identifying the specific characteristics of emotional, instrumental, and informational support. In this study, focus groups consisting of Gilda’s Club members explored the types of support that people with cancer and their caregivers experienced and valued. Results showed that although men and women with cancer and caregivers identify similar sources of support, they experience different types of support. Results also indicated a desire among participants to help and support others, a concept referred to as generativity. Implications for social workers and health care providers are explored.     

Attitudinal and contextual factors associated with discussion of sexual issues during adolescent health visits.

PURPOSE: To examine attitudinal and contextual factors associated with the occurrence of sexual health assessments during adolescent primary care visits. METHODS: A total of 313 primarily African-American youth aged 11-21 years from 16 community-based organizations in suburban Maryland and in New York City completed questionnaires focusing on sexually transmitted diseases (STD) and health care. The analysis examined the relationship of sexual activity, attitudes, and presence of the parent at the health care visit with discussion of three sexual health topics and testing for STD at the most recent health care visit. Data were analyzed using Chi-square tests and logistic regression. RESULTS: Overall, 74% of respondents reported that they had talked about at least one sexual health topic at their last health care visit but only 32% had discussed all three topics of sexual behavior, birth control, and STD. Females were more likely than males to discuss birth control although there were no gender differences in the overall likelihood of talking about a sexual health topic. Few adolescents initiated discussion of sexual issues. Positive attitudes toward discussing sexual issues with a provider and absence of a parent at the visit were independently associated with higher odds of discussing at least one sexuality topic and STD testing. CONCLUSIONS: Although relatively large numbers of adolescents in the sample received sexual health assessments, the proportion was below recommended guidelines. The opportunity to speak privately with a clinician and having positive attitudes about discussing sex with a doctor appear to be important influences on the receipt of sexual health assessments. Improving the quality of adolescent preventive care will require creating a health care environment that facilitates discussion of sexual health issues.     

Sexually transmitted diseases in Morocco: gender influences on prevention and health care seeking behavior

Increased awareness of the medical and social costs of sexually transmitted diseases (STD) has resulted in greater attention to the control of these illnesses. STDs are responsible for a significant amount of morbidity in Morocco and have become a key target of the HIV control program. In 1996, the Ministry of Health conducted a qualitative study in order to enhance information, education and communication strategies in the national STD/HIV program. Data on the conceptualization and knowledge of STD, information sources and health-care-seeking behavior were gathered through 70 semidirected, in-depth interviews conducted with men and women in the general population and health care providers (HCPs). Two commonly applied health behavior theories in STD/HIV prevention, the Health Belief Model (HBM) and the Theory of Reasoned Action (TRA) served as a framework for data analysis. The most common name for STD is berd, which means "the cold" in Moroccan Arabic. Berd is caused either by cold striking the genital area or sexual intercourse and most often designates a syndrome of genital discharge. However, the term was also often used to indicate STD in general. The dual causality of berd maintains social stability by providing an honorable excuse for individuals who become infected, while warning against unsanctioned sexual behavior. Clear gender differences in understanding STDs and health-care-seeking behavior emerged through these interviews. STDs in Morocco are viewed as women's illnesses and men with STD often reported feeling victimized by women. Men appear to have more extensive informal information sources for STD than women. Consequences of STD, both physical and psychosocial, were viewed as more severe for women than men, and men had greater access to treatment, for both social and economic reasons.     

School-Based Health Center Access,Reproductive Health Care,and Contraceptive Use Among Sexually Experienced High School Students

PurposeThe current analyses compared receipt of reproductive health care, contraceptive use, and screening for sexually transmitted diseases (STD) among adolescents who are sexually experienced, with or without access to a school clinic.MethodsA total of 12 urban California high schools, selected from areas with high teen pregnancy and STD rates, half with school-based health centers (SBHCs), participated in an intervention study designed to improve sexual health among adolescents. Of the participating students, 44% indicated that they had ever had intercourse and were included in these analyses.ResultsAccess to an SBHC did not influence receipt of reproductive health care for either males or females and did not influence contraceptive use, either hormonal or condoms, for males. For females, however, those with access to an SBHC had increased odds of having received pregnancy or disease prevention care (adjusted odds ratio [AOR] = 1.45, 95% confidence interval [CI] = 1.16–1.80), having used hormonal contraceptives at last sex (AOR = 1.68, 95% CI = 1.24–2.28), and were more likely to have ever been screened for an STD (AOR = 1.85, 95% CI = 1.43–2.40). Also among female students, those with access to an SBHC were more likely to have used emergency contraception at last sex (AOR = 2.1, 95% CI = 1.08–4.22).ConclusionAlthough access to an on-site clinic does not seem to lead to increases in all types of reproductive care in the population as a whole, sexually active females are more likely to have received more specific care and to have used hormonal contraceptives if their school has an SBHC.     

Contraceptive needs and practices among women attending an inner-city STD clinic.

To assess the potential need, interest, and benefits of provision of contraceptive services in sexually transmitted disease (STD) clinics, we surveyed 516 women attending an inner-city STD clinic regarding contraceptive and sexual practices, STD prevalence, knowledge of contraceptive-related STD prophylaxis, and interest in contraceptive services within the STD clinic setting. The study population was at high risk for unintended pregnancy and STDs; at time of interview 46 per cent of women were not contracepting and 59 per cent were treated for STD or STD exposure. Two-thirds of women had at least one prior pregnancy and 50 per cent had at least one living child. Only 26 per cent of women knew that some contraceptive methods may reduce the risk of STD acquisition; however, 62 per cent expressed interest in contraceptive methods which would reduce their risk of STD acquisition. This study suggests that provision of contraceptive services in STD clinic settings may address dual needs in a group at high risk for both unintended pregnancy and STD.     

Improving hepatitis B immunization among high-risk adolescents: a low-cost intervention on the Mexico-United States border.

OBJECTIVE: To analyze factors associated with hepatitis B immunization adherence among adolescents attending a sexually transmitted disease (STD) clinic in El Paso, a city in Texas that is on the border between Mexico and the United States of America. METHODS: In this cohort study with 248 adolescents we obtained data on demographics and health beliefs through personal interviews and medical record abstraction. We monitored each of the individuals for 8 months to determine whether the adolescents received a first, second, and third dose of the hepatitis B vaccine. RESULTS: Overall, 32% of the adolescents received the first immunization, 9% the second, and 2% the third. The strongest predictor of receiving either one or two doses was providing the vaccine at the STD clinic as opposed to referring adolescents to a separate vaccination clinic (relative risk (RR) for receiving the first immunization = 7.3; RR for receiving the second immunization = 3.8). Several health beliefs were also associated with receiving vaccinations. CONCLUSIONS: The results of our study indicate that hepatitis B vaccination programs can be improved through such steps as providing vaccinations at a convenient site, educating adolescents about hepatitis B risk factors, and emphasizing the difficulty of treating hepatitis B infection.     

Surveillance of STD syndromes: contributing to the STD programme in Côte d'Ivoire

In C?te d'Ivoire, management of sexually transmitted diseases (STDs) is based on a syndromic approach. The National Health Information System (NHIS), set up in 1995, supervises data drawn monthly on three STD syndromes: genital ulcers, discharges and warts. Information is collected in each community-based public clinic, collated in the 29 districts, then in the 10 regions, and finally centralized. We assessed the relevance of this information and its usefulness for the STD programme. The number of cases notified in adults of 15 years and above was compared in men and women for the years 1995 and 1996. The absolute number of cases was related to the number of consultations to evaluate the relative share of STDs in health care services, and to the population size to estimate STD annual incidence. Between 1995 and 1996, the number of reported STD cases remained steady in men, 32 410 and 31 470 cases, respectively, but increased by 35% in women, from 64 794 to 87 622 cases. As a result, STD annual incidence was unchanging in men (8%), but increased in women from 17 to 23%. However, between these two years, the relative contribution of STDs to all consultations decreased from 4.7 to 3.5% in men, while remaining steady in women, at around 7.0%. In this 2-year period, the ratio of the numbers of ulcers in men and women was about 1:1, and did not vary by district. In contrast, discharges were reported 2.7 times more by women, with a differing sex ratio from district to district. We suggest that vaginal discharges are often physiological, and are poorly instructive for STD surveillance. In contrast, ulcers in both genders, and male discharges, provide relevant information for the STD programme, for example to estimate the volume of STD drugs needed for public health services and to assess the epidemiological trends of STDs.     

Older, but not wiser: how men get information about AIDS and sexually transmitted diseases after high school

CONTEXT: As they reach adulthood, young men are less likely to use condoms and are at increased risk for exposure to AIDS and other sexually transmitted diseases (STDs). Little is known about which prevention efforts reach men in their 20s. METHODS: Longitudinal data from the 1988, 1990-1991 and 1995 waves of the National Survey of Adolescent Males are used to identify sources of information about AIDS and STDs among 1,290 young men aged 22-26. Information receipt from four main sources, the topics covered by each source and the personal characteristics associated with getting more information are all explored. RESULTS: Twenty-two percent of men surveyed discussed disease prevention topics with a health provider in the last year, 48% attended a lecture or read a brochure, 51% spoke to a partner, friend or family member, and 96% heard about AIDS or STDs from the media (e.g., television advertisements, radio or magazine). Excluding media sources, 30% of young men reported getting no STD or AIDS prevention messages in the last year. Being black or Hispanic, having had a physical exam or an AIDS test in the last year, and having discussions about AIDS or STDs with parents or a health care provider in the past were associated with receiving more information. CONCLUSIONS: Although young men who are at higher risk for STD or HIV infection are more likely than other young men to get information about disease prevention, young adult men are much less likely than adolescents to receive AIDS or STD prevention education. More prevention efforts need to be aimed at young adults.     

Prevalence and risk factors of Chlamydia trachomatis infection in clients of a venereal disease clinic in Amsterdam

We studied the prevalence of Chlamydia trachomatis (CT) infection as well as its predictors among a sample (1000) of visitors (651 male, 349 female) of a clinic for sexually transmitted diseases (STD) in Amsterdam. The prevalence of CT was higher than that of gonorrhoea: among men, 14.3% and 11.5% and among women, 12.9% and 6.3% respectively. Independent predictors for CT infections were for men: number of leucocytes in discharge or urine, nature of urethral discharge, age and sex behavior, and in women: being warned as source or contact of a STD, age, nature of cervical discharge and bleeding from the cervical ostium after insertion of a swab. As many as 92% of the male and 81% of the female visitors of our STD clinic should be examined for CT if the presence of anyone or more of these predictors is taken as a criterion. Even then, 5% of the CT infections in women would still be missed. Based on our study results, material for the diagnosis of CT will from now on be collected routinely from all female patients of our STD clinic as well as from all males with urethritis. We advocate the expansion in the Netherlands of facilities for laboratory CT detection and its standard inclusion in STD examination.     

The prevalence of sexually transmitted pathogens in patients presenting to a Casablanca STD clinic

The objective of this study conducted at the sexually transmitted diseases (STD) clinic of the Pasteur Institute of Morocco (SCPIM) is to describe clinical complaints and biological findings in patients attending this facility. Two thousand two hundred sixty-four patients had visited the STD clinic from 1992 to 1996. The main reported symptom was genital discharge for men (44.5%) and women (68.6%). Genital eruption and ulcer were more frequent in men. The principal biological result shows a seroprevalence of 0.62% for human immunodeficiency virus (HIV), 3.05% for hepatitis B virus (HBV), 51.5% for chlamydiae and 13.2% for syphilis. Factors associated with clinical findings were age and Gonococcus for men (odds ratio (OR): 1.94 and 5.96, respectively) and Trichomonas and positive TPHA for women (OR: 9.49 and 0.25, respectively). This work describes for the first time the distribution of various germs involved in sexually transmitted diseases in Moroccan population and underlines the importance of studying its sexual behavior as well as determinants of STD incidence.     

Teenagers' views on general practice consultations and other medical advice. The Adolescent Working Group, RCGP

BACKGROUND: The provision of health services for teenagers is of current interest in relation to primary care. OBJECTIVES: The main objective of the study was to look at satisfaction with the teenager's last consultation and any reasons for dissatisfaction. A further objective was to look at common teenage health concerns to identify how many teenagers had been concerned about them, where they sought advice, and to look at ratings of this advice. METHOD: Questionnaires were completed as part of a continuing evaluation of a novel sex education programme in 38 schools in 1997 and provided the data. The particular items reported in this study were related to satisfaction with the last GP consultation and reasons for dissatisfaction, health concerns and who (if anybody) was approached to address these concerns, and comments on services used. 5152 teenagers (51.8% male and 47.8% female) completed the questionnaires in a school lesson under conditions of complete confidentiality. RESULTS: Over 86% of adolescents were apparently satisfied with their last consultation with a GP, although several possible reasons were identified for any dissatisfaction. Health concerns were identified and sources of help were considered and compared; no obvious levels of relative dissatisfaction with services were noted. A large number of teenagers identified apparent concerns but did not seek help for these concerns. CONCLUSIONS: Adolescents are largely satisfied with the services available in primary care. A number of teenagers do not seek help for their own individual concerns. Encouraging teenagers to attend when they perceive a health problem may help provide a more sensitive primary care service.