Meta-Analysis of Alcohol and Serodiscordant Condomless Sex Among People Living with HIV

While observational studies have found that alcohol consumption is associated with serodiscordant condomless sex among people living with HIV (PLHIV), no meta-analysis has yet examined this trend. We conducted a meta-analysis to synthesize empirical evidence on the association between alcohol and condomless sex with partners at risk of HIV acquisition. To meet inclusion criteria, studies: (1) specifically targeted PLHIV or provided stratified data for HIV-infected participants; (2) provided a quantitative measure of alcohol use; (3) provided a quantitative measure of condomless sex with serodiscordant partners; and (4) reported the results of statistical tests examining the relationship between alcohol use and serodiscordant condomless sex. Using random-effects models, weighted effect sizes were calculated. Three separate analyses were conducted to examine serodiscordant condomless sex in association with any alcohol consumption, binge/problematic drinking, and alcohol in a sexual context. A total of 36 independent effect sizes from 27 studies (including 25,065 HIV-infected participants) were pooled in the meta-analysis. Any alcohol consumption, binge/problematic drinking, and alcohol use in a sexual context were each associated with condomless sex with serodiscordant partners [OR 1.64 (95% CI 1.46–1.85); OR 1.65 (95% CI 1.14–2.39); OR 2.88 (95% CI 2.01–4.12), respectively]. Meta-analytic findings demonstrate a consistent positive relationship between alcohol use and serodiscordant condomless sex among PLHIV. Future public health programming for HIV-infected individuals needs to address the role of alcohol consumption in sexual risk-taking behavior.     

Excessive alcohol use and its association with risky sexual behaviour: a cross‐sectional analysis of data from Victorian secondary school students

Objective : Estimate the prevalence of sexual behaviour and alcohol use and examine the association between excessive alcohol use and risky sexual behaviour in late secondary students in Victoria, Australia. Method: The sample of Year 11 students from government and independent schools participating in the 2008 International Youth Development Study (n=450) was representative of the Victorian school population. Logistic regression analyses examined the associations between sexual behaviour, binge and compulsive drinking, adjusting for socio‐demographic, school and family factors. Results: Under half (44%) the students had experienced sex in the past year, half (50%) had engaged in binge drinking in the past two weeks and 26% reported compulsive drinking in the past year. Of those who reported sex in the past year (n=197), 34% had sex without a condom at the last sexual encounter and 28% later regretted sex due to alcohol. The likelihood of experiencing sex was increased by binge (OR=2.44, 95%CI 1.44–4.12) and compulsive drinking (OR=2.15, 95%CI 1.29–3.60). For those sexually active, binge drinking increased the risk of having three or more sexual partners (OR=3.37, 95%CI 1.11–10.26) and compulsive drinking increased the likelihood of regretted sex due to alcohol (OR=4.43, 95%CI 2.10–9.31). Excessive drinking was not associated with condom non‐use. Conclusion and implications: Risky sex – multiple sexual partners and regretted sex due to alcohol – and excessive drinking are highly prevalent and co‐associated among Victorian late secondary students.     

Sex trade involvement and rates of human immunodeficiency virus positivity among young gay and bisexual men

BACKGROUND: Susceptibility to human immunodeficiency virus (HIV) infection is of particular concern for marginalized populations. The objective of this study was to determine risk factors associated with sex trade work among young gay and bisexual men. Further, we aimed to compare HIV prevalence and incidence among men involved and not involved in sex trade work. METHODS: The study is based upon data obtained from a prospective cohort study of young gay and bisexual men. Participants had completed a baseline questionnaire which elicited information on demographic information, sexual behaviours, and substance use. Sex trade involvement was defined as the exchange of money, drugs, goods, clothing, shelter or protection for sex within the one year prior to enrollment. Contingency table and multivariate logistic regression analyses were used to identify risk factors associated with involvement in the sex trade. RESULTS: Of the 761 eligible participants, 126 (16%) reported involvement in sex trade work. Multivariate logistic regression analysis revealed regular alcohol use (Odds Ratio [OR] = 3.6, 95% CI : 1.8-7.2), aboriginal ethnicity (OR = 3.7, 95% CI : 1.6-8.7), unemployment (OR = 3.9, 95% CI : 2.1-7.3), history of residence in a psychiatric ward (OR = 4.2, 95% CI : 1.8-9.8), bisexual activity (OR = 7.0, 95% CI : 3.5-14.1) and the use of crack (OR = 7.4, 95% CI : 3.0-18.7) to be independently associated with sex trade work. Sex trade workers had a significantly higher HIV prevalence at baseline compared with non-sex trade workers (7.3% versus 1.1%, P < 0.001). As well, HIV incidence was found to be significantly higher for sex trade workers compared with non-sex trade workers (4.7% versus 0.9%, P = 0.011). CONCLUSION: Our study reveals that for male sex trade workers in this setting increased vulnerability to HIV infection is related to unfavourable living conditions, substance use and sexual risk behaviour.     

HIV risk behavior and work in Uganda: a cross-sectional study

OBJECTIVE: The study assessed the prevalence of factors associated with HIV risky behaviour among employees of a Sugar Factory in Jinja District, Uganda. METHODS: A cross-sectional study of 321 participants was carried out in a Sugar Factory where several workers were migrants. Using an interviewer-administered questionnaire, information on socio-demographic characteristics, work factors and sexual behaviours was obtained. RESULTS: Fifty-one percent of the men and 32% of the women reported having multiple sex partners in the past year. Thirty-six percent of the respondents reported using condoms during the last casual sex. Twenty-four percent of men and 15% women reported sexually transmitted infection-related symptoms in the last one-year. Having multiple sex partners was associated with being a contract worker (OR = 2.1, 95% CI = 1.10-3.79) and being married but not living with spouse (OR = 2.1, 95% CI = 1.16-4.00). CONCLUSION: HIV risk behaviour among Sugar Factory workers is associated with separation from partner. HIV intervention strategies should include work related factors of this type.     

HIV阳性男男性行为者对男性固定性伴性传播危险分析

目的 了解有高危性行为的HIV阳性男男性行为人群（men who have sex with men,MSM）对男性固定性伴的性传播危险状况,探讨对固定性伴性传播危险相关联的因素。方法 采用滚雪球抽样方法,在上海和成都市招募有高危性行为的HIV阳性MSM作为研究对象,运用匿名方式,进行一对一问卷调查。结果 研究对象中,最近6个月对男性固定性伴有性传播危险的比例为26.9%（83/308）;多因素分析显示,确认HIV感染时间<1年者对男性固定性伴传播危险,分别是HIV感染确认时间在1～2年和≥3年者的3倍（OR=0.34,95%CI:0.15～0.79）和6倍（OR=0.17,95%CI:0.06～0.49）;将HIV感染状况告知全部男性固定性伴的调查对象,对男性固定性伴的传播危险是全部未告知者的1/25（OR=0.04,95%CI:0.01～0.13）;家人知晓HIV感染状况者对男性固定性伴传播危险降低到1/4（OR=0.24,95%CI:0.10～0.55）;通过互联网寻找性伴者对男性固定性伴的传播危险是其它途径的3倍（OR=0.33,95%CI:0.14～0.78）。结论 HIV阳性MSM与男性固定性伴间存在的性传播危险可能加速HIV在MSM人群中的扩散。强化性伴告知、及早抗病毒治疗及新媒体干预等方法可望发挥遏制HIV继续传播的作用。     

Association of hepatitis B virus infection with other sexually transmitted infections in homosexual men. Omega Study Group

OBJECTIVES: This study determined the prevalence and factors associated with hepatitis B virus (HBV) infection among men who have sex with men. METHODS: At the baseline visit of an HIV study among men who have sex with men, we asked about HBV vaccination status and tested for HBV markers. RESULTS: Of 625 subjects, 48% had received at least 1 dose of HBV vaccine. Of 328 unvaccinated men, 41% had 1 or more HBV markers. HBV prevalence increased markedly with age and was associated with many sexual and drug-related behaviors. In a multivariate model, 7 variables were independently associated with HBV infection: ulcerative sexually transmitted diseases (odds ratio [OR] = 10.1; 95% confidence interval [CI] = 2.6, 54); injection drug use (OR = 5.2; 95% CI = 1.2, 26); gonorrhea or chlamydia (OR = 4.0; 95% CI = 1.9, 8.9); sexual partner with HIV/AIDS (OR = 3.6; 95% CI = 1.8, 7.1); 50 or more casual partners (OR = 3.4; 95% CI = 1.6, 7.1); received money for sex (OR = 3.0; 95% CI = 1.2, 7.8); and 20 or more regular partners (OR = 2.5; 95% CI = 1.1, 6.1). CONCLUSIONS: In Montreal, men who have sex with men are at risk for HBV infection, but a substantial proportion remain unvaccinated; new strategies are required to improve coverage. Men who have sex with men and who have a sexually transmitted infection, especially a genito-ulcerative infection, appear to be at particularly high risk for HBV infection.     

Mental representation of self in relationships indirectly affects young Black women’s engagement in risky sexual behaviors through psychosocial HIV/STI risk factors

Black females are disproportionately affected by human immunodeficiency virus (HIV)/sexually transmitted infections (STIs), though individual-level sexual risk factors do not appear to explain racial/ethnic HIV incidence rate disparities. The current study examined the roles of attachment representations, working models of self and others, with psychosocial risk factors related to population-level sexual network features in association with risky sexual behaviors. A total of 560 Black emerging adult females (M age = 20.58, SD = 1.89) enrolling in a behavioral HIV prevention intervention trial completed the baseline assessment used in the current analyses. A series of multiple mediator models examined indirect effects of working models of self and others on sexual risk engagement through the following psychosocial HIV/STI risk factors: (a) partner communication self-efficacy, (b) fear of condom negotiation, (c) peer norms for risky sexual behavior, (d) partner trust and (e) sex-related alcohol expectancies. Results indicated an indirect effect of working model of self on the following: condom use with boyfriend/main partner through peer norms for risky sex (ab = .08, 95% CI [.02, .17]), any alcohol use prior to sex through peer norms for risky sex (ab = ?.06, 95% CI [?.12, ?.02]) and alcohol use prior to sex through sex-related alcohol expectancies (ab = ?.13, 95% CI [?.21, ?.05]). Findings provided evidence of a direct association between working model of self and each psychosocial HIV/STI risk factor included in the mediation models. Working model of self may help identify Black females at elevated risk for HIV/STI through these psychosocial risk factors.     

Substance use and risky sexual behaviours among sexually experienced Ghanaian youth

ABSTRACT: BACKGROUND: The association between risky sexual behaviours and substance uses among Ghanaian youth were investigated. METHODS: An in-school cross-sectional representative survey was conducted among 12-18-year- old youth in Ghana in 2008 (N=1165, response rate =90%). Logistic regression analyses were employed to investigate the association between substance use (tobacco use, drunkenness, marijuana use, other drug uses) and risky sexual behaviours (sexual debut, condom use and number of sexual partners). RESULTS: Of all adolescents, 25% (28% boys and 23% girls) were sexually experienced. The mean age for first sexual intercourse was 14.8 years (14.4 years for boys and 15.1 years for girls). Among the sexually experienced, 31% had multiple sexual partners. Older age (OR=3.4, 95% CI=1.7-3.4) and rural residency (OR=1.5, 95% CI=1.1-2.1) were independently associated with sexual debut while only older age (OR=2.4, 95% CI=1.7-3.4) was associated with condom use. Additionally, smoking (OR=3.7, 95% CI=2.0-6.8), tawa use (OR=2.4, 95% CI=1.3-4.7), tobacco use (OR=2.8, 95% CI=1.7-4.7) drunkenness (OR=1.7, 95% CI=1.1-2.8) and marijuana use (OR=3.3, 95% CI=1.6-7.0) were independently associated with sexual debut. Furthermore, all substance uses studied were associated with having one or multiple sexual partners. CONCLUSION: Substance use seems to be a gateway for risky sexual behaviours among Ghanaian adolescents. Public health interventions should take into account the likelihood of substance use among sexually experienced adolescents.     

Transactional sex among women in Soweto, South Africa: prevalence, risk factors and association with HIV infection

Sex workers have long been considered a high-risk group for HIV infection, but to date little quantitative research has explored the association between HIV risk and exchange of sex for material gain by women in the general population. The objective of this study was to estimate the prevalence of such transactional sex among women attending antenatal clinics in Soweto, South Africa, to identify demographic and social variables associated with reporting transactional sex, and to determine the association between transactional sex and HIV serostatus. We conducted a cross-sectional study of women seeking antenatal care in four Soweto health centres who accepted routine antenatal HIV testing. Private face-to-face interviews covered socio-demographics, sexual history and experience of gender-based violence. 21.1% of participants reported having ever had sex with a non-primary male partner in exchange for material goods or money. Women who reported past experience of violence by male intimate partners, problematic substance use, urban residence, ever earning money, or living in substandard housing were more likely to report transactional sex, while women who reported delayed first coitus, were married, or had a post-secondary education were less likely to report transactional sex. Transactional sex was associated with HIV seropositivity after controlling for lifetime number of male sex partners and length of time a woman had been sexually active (OR = 1.54, 95% CI: 1.07, 2.21). Women who reported non-primary partners without transactional sex did not have increased odds of being HIV seropositive (OR = 1.04, 95% CI: 0.75, 1.43). We conclude that transactional sex may place women at increased risk for HIV, and is associated with gender-based violence, substance use and socio-economic disadvantage. Research, policy and programmatic initiatives should consider the role of transactional sex in women's HIV risk, with attention to the intersecting roles of violence, poverty, and substance use in shaping women's sexual behaviour.     

The influence of psychosocial factors,alcohol, drug use on African-American women’s high-risk sexual behavior

Objectives: The present study examines psychosocial and behavioral influences, particularly drug and alcohol use, as correlates of inconsistent condom use and having multiple sexual partners during the past month among African-American women.Methods: This cross-sectional study, conducted between May and June 1996, recruited a convenience sample of 180 African-American women in Birmingham, Alabama. Women completed a face-to-face interview that assessed alcohol and drug use, sexual behaviors, depression, condom use, and negotiation skills.Results: The majority of women, 51.6% (n = 93), had used either alcohol or drugs during the previous month. Many women, 31.1%, consumed alcohol, 18.3% used marijuana, and 8.3% had smoked crack within the past month. Nearly 42.7% of women used condoms inconsistently in the past month and 13.3% of women had multiple sexual partners within the past month. A logistic regression model predicting inconsistent condom use indicated that women were less likely to use condoms if they consumed alcohol between 20 and 30 days of the month (OR = 2.8, 90% CI = 1.3–5.9) and if they had not negotiated condom use (OR = 32.4, 90% CI = 7.9–131.6). The logistic regression model predicting multiple sexual partners indicated that women were more likely to have multiple sexual partners if they had smoked crack in the past month (OR = 5.3, 90% CI = 1.6–18.2).Conclusion: HIV sexual risk-reduction interventions for African-American women need to address the overlapping epidemics of drugs, alcohol, and STDs. Additionally, HIV sexual risk reduction efforts should be incorporated into existing drug and alcohol treatment programs and STD clinics.     

男男性行为人群性角色状况及其与安全套使用和HIV检测的关系

目的了解成都市男男性行为人群（men who have sex with men,MSM）中性角色状况及其与安全套使用和HIV检测的关系,为发展适合MSM不同亚群特点的HIV预防干预策略提供依据。方法采用分类滚雪球抽样法招募MSM,由统一培训的调查员进行面对面的问卷调查。结果共招募MSM 191人,其中29.8%只作为或多数情况下作为插入方（1号）、31.4%只作为或多数情况下作为被插入方（0号）、38.7%作为插入方和被插入方的情况相差不多（0.5号）;过去半年内与男性固定性伴肛交时,49.7%坚持使用安全套,0号与1号相较于0.5号更倾向于坚持使用安全套（0号：OR=5.43,95%CI：2.26～13.07;1号OR=3.40,95%CI：1.42～8.12）;过去半年内与男性偶然性伴肛交时,58.7%坚持使用安全套,0号与1号相较于0.5号更倾向于坚持使用安全套（0号：OR=2.63,95%CI：1.01～6.83;1号OR=4.08,95%CI：1.52～10.96）;最近1年内,77.0%接受过HIV检测,0.5号、1号接受HIV检测率高于0号（0.5号：OR=2.26,95%CI：1.01～5.05;1号：OR=3.42,95%CI：1.27～9.21）。结论不同肛交性角色的MSM在安全套使用和HIV检测上存在差异,可根据性角色针对性开展艾滋病防治工作。     

Double trouble: violent and non-violent traumas among women at sexual risk of HIV infection

BACKGROUND: This study examines the association between trauma and HIV risk behaviors among women at sexual risk for HIV infection. METHODS: From April to August 1998, high-risk HIV negative women were recruited in the South Bronx into a year-long cohort study. At the 12-month visit, 116 women were interviewed face-to-face about recent and lifetime violent and non-violent traumas. RESULTS: The women reported a substantial prevalence of sexual risk behaviors associated with the acquisition of HIV. At baseline, almost two-thirds (64%) reported unprotected vaginal sex in the previous six months, and in the previous year, 62% had smoked crack, 52% reported sex-for-money-or-drugs exchanges, and 47% had five or more male sex partners. The lifetime prevalence of trauma was high: 81% had experienced one or more violent traumas and 97% had experienced one or more non-violent traumas. Women who had experienced violent trauma--physical assault by a partner (OR = 2.88; 95% CI 1.12; 7.41)--and those who had experienced non-violent trauma--loss of a child to foster care (OR = 3.34; 95% CI 1.04; 10.65)--were more likely to use crack than others. Those who had experienced non-violent trauma, by witnessing a physical assault (OR = 2.31; 95% CI 0.99; 5.40), were also more likely than others to have exchanged sex. CONCLUSIONS: Both violent and non-violent traumas appear to play a role in the behaviors that place women at risk of HIV infection, particularly using crack and exchanging sex.     

HIV感染者/AIDS患者的家属及朋友感染HIV的相关因素分析

目的 探讨人类免疫缺陷病毒（human immunodeficiency virus,HIV）感染者/获得性免疫缺陷综合征（acquired immunodeficiency syndrome,AIDS）患者的家属及朋友感染HIV的现状和相关影响因素。方法 采取横断面研究设计,通过方便抽样方法和自行设计的调查问卷,于2013年3～6月对广州市第八人民医院感染科住院及门诊部的192名HIV感染者/AIDS患者的家属及朋友进行面对面问卷调查。结果 192位HIV感染者/AIDS患者的家属及朋友中,感染者家属占86.5%（166/192）,感染者家属及朋友的HIV感染率为36.5%（70/192）。多因素Logistic回归分析表明,与感染者的关系为配偶或性伴（OR=4.464,95%CI:2.128～9.366）、同性恋/双性恋（OR=4.523,95%CI:1.676～12.209）、吸毒（OR=6.755,95%CI:1.720～26.528）是感染者家属及朋友感染HIV的危险因素;与感染者感情关系亲密（OR=0.229,95%CI:0.097～0.539）是其感染HIV的保护因素。结论 HIV感染者/AIDS患者的配偶或性伴与其存在着性关系,故感染HIV风险较其他亲友高,但与HIV感染者/AIDS患者感情亲密的配偶或性伴较感情疏远者感染HIV风险低。同性恋/双性恋、吸毒是感染HIV的高危因素。关于与HIV感染者/AIDS患者感情关系和除配偶或性伴以外其他亲友感染HIV的相关关系,仍需进一步研究。     

Factors associated with HIV sero-status in young rural South African women: connections between intimate partner violence and HIV

BACKGROUND: This paper aims to describe factors associated with HIV sero-status in young, rural South African women and the relationship between intimate partner violence (IPV) and HIV. METHODS: A total of 1295 sexually active female volunteers, aged 15-26, from 70 villages were recruited to participate in a cluster randomized controlled trial of an HIV behavioural intervention. The main measures were HIV sero-status, and IPV and sexual practices measured using a questionnaire administered during baseline interviews. RESULTS: About 12.4% of women had HIV and 26.6% had experienced more than one episode of physical or sexual IPV. After adjusting for age, HIV infection was associated with having three or more past year partners [odds ratio (OR) 2.39; 95% confidence interval (95% CI) 1.48-3.85], sex in past 3 months (OR 3.33; 95% CI 1.87-5.94), a partner three or more years older (OR 1.69; 95% CI 1.16-2.48), and a more educated partner (OR 1.91; 95% CI 1.30-2.78). IPV was associated with HIV in two-way analyses (OR 1.56; 95% CI 1.08-2.23), but the effect was non-significant after adjusting for HIV risk behaviours. The experience of IPV was strongly associated with past year partner numbers, time of last sex, and partner's education; it was also marginally associated with partner age difference. Adverse experiences in childhood, including sexual abuse, increased the likelihood of having more past year partners (OR 1.43; 95% CI 1.21-1.69). CONCLUSIONS: IPV was strongly associated with most of the identified HIV risk factors. Our findings provide further evidence of links between IPV and HIV among women and the importance of joint prevention.     

中越边境地区暗娼人群HIV感染及性行为特征对比分析

  目的  了解中越边境地区中国籍与越南籍暗娼人群(female sex workers, FSWs)的人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染现状,分析两组人群HIV感染相关因素以及性行为特征。  方法  2015-2016年期间在云南省河口县开展横断面调查,方便抽样纳入中国籍与越南籍FSWs。问卷收集调查对象的社会人口学特征、HIV相关知识态度、性行为等信息;采集血液样本进行HIV、单纯疱疹病毒2型(herpes simplex virus type 2, HSV-2)以及梅毒感染检测;多因素Logistic回归分析模型筛选HIV感染相关因素。  结果  合计纳入1 263名FSWs,中国籍调查对象227人,HIV感染率为0.44%;越南籍调查对象1 036人,HIV感染率为2.12%。越南籍FSWs最近1月商业性性伴数量以及性服务费用均高于中国籍FSWs(均有P＜0.001)。经多因素Logistic回归分析模型分析,HSV-2感染(OR=3.83, 95% CI: 1.37~10.76; P=0.032)、HIV知识知晓不合格(OR=10.40, 95% CI: 3.77~28.66; P=0.001),以及接受HIV相关干预服务(OR=0.27, 95% CI: 0.08~0.84; P=0.022)是越南籍FSWsHIV感染的相关因素。  结论  中国籍与越南籍FSWs感染HIV的风险模式可能存在差异,后续HIV干预工作应针对越南籍FSWs增加服务的覆盖与可及性;对于中国籍FSWs,建议加强与固定性伴安全套使用的行为干预。     

云南、广西两省四县（区）人类免疫缺陷病毒感染者检测结果告知意愿及影响因素分析

目的了解云南、广西两省四县（区）人类免疫缺陷病毒（HIV）感染者检测结果的告知意愿及影响因素。方法采用方便抽样,对云南和广西两省四县（区）于2008年1～12月期间检出的HIV感染者采用自行编制的匿名问卷进行一对一调查,调查HIV阳性人群HIV检测阳性结果的告知对象、告知意愿及相关影响因素。结果361名调查对象中,愿意将HIV检测阳性结果告知固定性伴、非固定性伴、亲人和朋友的比例分别占72．6％,22．0％,63．2％和6．2％。单因素和多因素Logistic回归分析结果显示,年龄（OR=3．73,95％CI：1．22—11．38）,艾滋病知识知晓（OR=63．13,95％CI：20．76～191．97）与探讨性伴告知（OR=2．32,95％CI：1．01～5．79）在固定性伴告知意愿上的差别有统计学意义。结论部分HIV感染者不愿意将HIV阳性状态告知他人,应进一步开展艾滋病健康教育,不断提高HIV检测阳性结果的告知意愿,减少家庭或同伴感染概率,防止HIV二代传播。     

Mental health and sexual risk behaviours in a South African township: a community-based cross-sectional study

OBJECTIVES: Despite the high prevalence of both mental illness and human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in developing countries, there are few data on the association between different forms of mental illness and sexual risk behaviours in resource-poor settings. The objective of this study was to examine the association between mental illness and HIV risk behaviours in a South African township. STUDY DESIGN: A cross-sectional study was performed among 645 individuals living in households selected at random. METHODS: A self-administered translated questionnaire investigated sexual risk behaviours [including sexual partners, condom use, casual sexual contacts, and sex in exchange for money, drugs or a place to stay (transactional sex)], depression (measured using the Center for Epidemiological Studies Depression Scale), alcohol abuse (from the Alcohol Use Disorders Identification Test), and post-traumatic stress disorder (based on the Life Event Checklist). RESULTS: Of the 645 individuals who completed the survey, 33% reported depression, 17% reported alcohol abuse, and 15% reported post-traumatic stress disorder. After adjusting for demographic characteristics, the presence of any of these three conditions was strongly associated with experiences of forced sex [adjusted odds ratio (AOR) 2.53; 95% confidence intervals (CI) 1.60-4.02], transactional sex (AOR 2.88; 95% CI 1.29-6.48) and increased condom use (AOR 2.07; 95% CI 1.32-3.25). CONCLUSIONS: These findings emphasize the substantial burden of mental illness in this setting, and its association with forced and transactional sex. The temporal nature of these associations is not always clear from this cross-sectional study, and additional prospective research is required. Public health interventions are needed to address the dual burden of HIV/AIDS and mental illness in this and similar settings.     

HIV infection, genital ulcer disease, and crack cocaine use among patients attending a clinic for sexually transmitted diseases.

BACKGROUND. Recently there has been a rise in genital ulcer disease (GUD) in urban minority heterosexuals in the United States. The impact of these increased GUD rates on HIV transmission patterns in this population is unknown. METHODS. Sexually transmitted disease (STD) diagnoses were correlated with HIV antibody status and risk factor history in 194 patients who consented to HIV testing at an STD clinic in central Brooklyn. RESULTS. Of 36 HIV-positive patients, 23 (64%) denied HIV risk factors other than heterosexual contact with persons of unknown HIV status. HIV antibody was associated with GUD (odds radio [OR] = 2.72, 95% confidence interval [CI] = 1.20-6.24), multiple concurrent STDs (OR = 2.51, 95% CI = 1.08-5.81), and a history of crack cocaine use (OR = 2.98, 95% CI = inexact-9.61). Crack use was also associated with GUD (OR = 15.15, 95% CI = 3.27-inexact) and multiple simultaneous STDs (OR = 13.87, 95% CI = 4.62-inexact). In a log-linear model analysis, HIV infection was independently associated with GUD and crack use. HIV infection, genital ulcer disease, and crack cocaine use were more common in women than men. CONCLUSIONS. The association between HIV infection and GUD seen here may be secondary to high-risk sexual behavior, which in turn may be partially attributable to crack cocaine use and drug-related prostitution. The high rate of coinfection with HIV and GUD raises a concern about the increased efficiency of sexual transmission of HIV in this population.     

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.