Prevalence of antibodies to human immunodeficiency virus type 1 and condom use among outpatients at a sexually transmitted disease clinic in rome

To assess the prevalence of HIV-1 infection and study selected risk factors among patients attending a clinic for sexually transmitted diseases in Rome, 1442 outpatients seen consecutively between 20 February and 12 December 1989 were anonymously tested for anti-HIV-1. An evaluation of the trend of the HIV-1 infection was attempted by comparing the results of the present study with those obtained from a similar sample studied in 1986 in the same clinic. The overall estimated prevalence of anti-HIV-1 was 1.2 % among heterosexual non-drug user subjects and 16.1 % among homosexual or bisexual men. The anti-HIV-1 seropositivity was significantly higher in heterosexual subjects who reported sexual contact with intravenous drug users, as compared with those who did not report such exposure (12.5 % vs 0.8 %, p<0.005). Comparing the present data with those of a study conducted in 1986 in the same clinic, a lower prevalence of anti-HIV-1 was found among heterosexual subjects (1.2 % in 1989 vs 6.0 % in 1986, p<0.001). The availability after 1986 of several outpatient facilities attracting seropositive subjects and a change in the sexual behaviour of anti-HIV-1 positive subjects could explain this finding. Twenty percent of the heterosexual subjects and 62 % of the homosexual or bisexual men reported consistent use of condoms. In both heterosexual subjects and homosexual/bisexual men only the number of sexual partners in the previous year seemed to be related to the use of condoms, a higher proportion of subjects with two or more partners reporting the use of condoms, as compared with monogamous subjects (29.5 % vs 11.5 %, p<0.001 and 68.0 % vs 37.0 %, p<0.005). The infrequent use of condoms, in particular among heterosexual subjects, suggests that education campaigns conducted so far were partly effective.     

Informing school sex education using the stages of change construct: sexual behaviour and attitudes towards sexual activity and condom use of children aged 13-16 in England

A survey of 3820 school children in England aged 13-16 years examined sexual activity using the Transtheoretical Model (TTM) Stages of Change. A quarter (26%) of teens were sexually experienced, 44.8 per cent did not use contraception and 48.9 per cent did not use condoms, every time. Past history of condom and contraceptive use, and partner willingness to use condoms were the best predictors of being in Action or Maintenance stage for condom use. Of virgins, 19.82 per cent were in Contemplation or Preparation stages for intercourse, and 85.4 per cent would use condoms every time. Sex education should be tailored to Stage, and signposting to sexual health and contraception services.     

Predicting Intended Condom Use among Tanzanian Students using the Theory of Planned Behaviour

This study examined whether perceived behavioural control predicted the intention to use condoms at next sexual intercourse above the components of the theory of reasoned action, as well as the sufficiency of the theory of planned behaviour (TPB) as a theory of intention among Tanzanian adolescents. Five hundred and twenty-eight students who were sexually active, from seven secondary schools in Arusha, Northern Tanzania, completed a questionnaire designed to measure the components of the TPB. Behavioural intentions were significantly predictable from attitudes (.11), subjective norms (.22) and perceived behavioural control (.48). The inclusion of past behaviour into the regression equation increased R(2) only marginally (2 percent) but significantly, suggesting that the TPB provides a fairly accurate explanation of intention to use condoms among Tanzanian adolescents. The implications of this finding in relation to theoretical and practical issues are discussed.     

Attitudes toward condom use and AIDS among patients from an urban family practice center

As part of an effort to better educate patients about using condoms, a survey was done to assess the sexual practices, attitudes toward acquired immunodeficiency syndrome (AIDS) and condom use by patients who visit an urban family practice center. A self-administered questionnaire was given to 126 patients of whom the majority were black and single. Seventeen percent indicated they had sex with more than one person in the 3 months before the survey. Within the last 5 years, 10% had sex with an intravenous drug abuser, and 6% with someone of the same sex. Fifty percent believed that condoms decrease sexual pleasure for men and 31% thought condoms made sex inconvenient. Twenty-seven percent of those surveyed believed that a man's penis may be too large for a condom and 18% believed that uncircumcised men could not use condoms. Forty-five percent believed they should be screened for human immune deficiency virus exposure. The results highlight attitudes and beliefs that may function as barriers to condom use and should be addressed when encouraging condom use with this population.     

Characteristics of African-American college students with HIV/AIDS.

This article examines the risky sexual behaviors, condom and drug usage, sexually transmitted diseases (STDs), and attitudes of African-American college students with the human immunodeficiency virus (HIV), which is the precursor of the acquired immunodeficiency syndrome (AIDS). A total of 408 (199 males, 209 females) African-American college students, representing 75% of the students enrolled in a southern university, were surveyed. The results revealed that 3.18% of the students reported having HIV/AIDS. The students with HIV/AIDS exhibited significant deficits in AIDS knowledge, particularly information concerning the transmission of HIV/AIDS. While subjects with HIV/AIDS did not differ from subjects without HIV/AIDS with regard to their perceived risk of being exposed to AIDS or their attitudes about using condoms, a significantly larger percentage of subjects with HIV/AIDS reported that they "always" used condoms with their partner. Nevertheless, subjects with HIV/AIDS were more likely to engage in anal intercourse, experience sex with prostitutes, and use drugs. Sexually transmitted diseases were more prevalent among subjects with HIV/AIDS, and syphilis was found to be the best predictor of HIV/AIDS.     

Predictors of HIV Risk Among College Students: A CHAID Analysis1

SUMMARY The purpose of this study was to identify predictors of risk behaviors among college students and to determine how students differed in HIV risk practices. Participants were from six colleges and universities in a large southeastern metropolitan area. The present analysis was limited to participants who were 18 to 25 years of age; single; White, African American, or Asian; and reported initiation of sexual intercourse. The results demonstratedsignificant associations of gender and race with having sex within the past3 months, number of partners, condom use, length of time one knew one's sexual partner, substance use, and asking one's partner about sexualhistory. Using Chi-Square Automatic Interaction Detection (CHAID), the strongest predictor of condom use was noted to be gender, and the strongest predictor of number of partners was race. The findings of this study indicate that HIV risk factors vary dependingon a college student's ethnicity, gender, academic status, and substanceuse. Most importantly, African American men, particularly men who use drugs, and White and Asian men who use alcohol tend to report higher numbers of sexual partners. Females, particularly upperclass White females, and White men who do not use alcohol report infrequent condom use. These findings areuseful for health educators who have begun to recognize the importance ofconsidering the HIV risk factors of students and incorporating informationrelated to these factors into HIV prevention programs. From the results ofthis study, we have several suggestions that health educators and researchersmay want to consider when developing programs for college students: 1. Although students may not need extensive information about basic HIVfacts, they may need reinforcement of the information. In particular, students need to be made aware that lambskin condoms do not offer protection against HIV transmission. 2. Females need to be encouraged and taught the skills to negotiate theuse of and to actually use condoms. These skills need to be reinforced throughout college, particularly as women adopt other methods of birth control (i.e., the pill). 3. The general acceptance of condom use among African Americans and Asians may be a useful tool for the health educator. Promoting and reinforcingthis norm and behavior, while addressing some of the other risk factors inthese groups, may be a particularly effective approach to HIV prevention. 4. For White students whose condom use rates are lower, messages can include the use of condoms for STD and pregnancy protection. Messages for male students could include control over preventing pregnancy or sharing control for pregnancy prevention. 5. Couples often abandon using condoms when they feel they know each other “well enough.” Some guidelines for when to give up condoms might also be given to provide couples with responsible and realistic directions for minimizing their risk when choosing to engage in unprotected sex. These guidelines would include HIV testing two times at least 6 months apart, no evidence of STDs in either partner, and a commitment of both partners to a monogamous relationship. 6. When addressing the number of sexual partners as a risk factor, African American men and women may hold the greatest potential for change, given the greater likelihood of multiple partners in these groups. 7. With respect to drug and alcohol use, health educators may want to include discussions about the influence of drugs (particularly for African American students) and alcohol (particularly for White and Asian students) on inhibiting logical decision-making as it relates to sexual intercourse.     

Risk factors and HIV transmission to midlife and older women: knowledge,options, and the initiation of safer sexual practices

Despite the increased impact of HIV/AIDS on women in the United States, the HIV-related experience of mature and older women has been largely overlooked by behavior scientists. Appropriate strategies for increasing awareness, assessing personal risk, and implementing safer sex behaviors among women in their 50s or older have not been developed. Relative to knowledge of personal risk and self-protective measures, older women have lower levels of knowledge about HIV/AIDS and the effectiveness of condoms than their younger counterparts. Although a significant portion of postmenopausal women remain sexually active, little is known about how mature women in long-term relationships can initiate self-protective behaviors if they come to recognize a risk or how those who meet new sexual partners can be motivated to use condoms. Investigations regarding safer sexual practices must be conducted in a way that addresses biologic events (e.g., menopause), life course changes, and cohort effects. Rather than trying to generalize findings from studies performed with younger women, it is necessary to integrate risk reduction strategies into models of sexual health and well-being for women across their life course.     

Why do heterosexual young adults who use reliable contraception also use condoms? Results from a diary‐based prospective longitudinal study

Objectives. To identify characteristics of individuals and characteristics of sexual encounters that predict whether people using contraception will also use condoms (dual use), and to determine whether dual use is prompted by concerns about unplanned pregnancy and/or sexually transmitted infections (STIs). Design. A longitudinal prospective design was used to identify characteristics of individuals and characteristics of specific sexual encounters that predict condom use. Methods. A sample of 349 sexually active heterosexual young adults was recruited at universities and trade colleges in Melbourne, Australia. Participants completed a self‐administered questionnaire, and a representative subsample (N = 103) completed a structured condom use diary in which they reported on up to 10 instances of vaginal intercourse. Respondents reported use of condoms and other forms of contraception during 919 instances of vaginal intercourse. Results. In multivariate analyses, dual use of condoms in addition to other contraception was predicted by attitudes toward condoms, intentions to use condoms, partner type and discussion of condom use with sexual partners. Dual use was not related to greater concern about HIV/STIs or unplanned pregnancy. Conclusion. Encouraging heterosexual young adults to discuss condom use, and developing their skills for negotiation of condom use will increase rates of condom use, thereby reducing current high rates of unplanned pregnancy and STIs.     

Characteristics of women seeking emergency contraception in general practice

The aim of this study was to profile the users of emergency contraception (EC) attending general practices and a general practice out-of-hours co-operative service using a pre-piloted questionnaire. Questionnaires were offered to 171 women and completed by 144 (84.2%). Mean age was 24.4 years (Standard Deviation = 6.7, range 14 to 51). Most were single, 116 (80.6%). Those who had no regular partner at the time of seeking EC were more likely to have > or =6 lifetime sexual partners than those in stable relationships (OR: 3.5; CI: 1.14-10.86, p < 0.03). At the time of seeking EC 121 (84.0%) were using some method of contraception. Ninety-three (64.6%) presented within 24 hours of sexual intercourse. Concerns about condoms were the commonest reason for seeking EC. For 55 (38.2%) this was their first time to use EC. Thirty-three (22.9%) were drunk at the time of intercourse.     

The relationship of male self-report of rape supportive attitudes,sexual fantasy,social desirability and physiological arousal to sexually coercive stimuli

Studies have supported the finding that sexually coercive behavior exists between males and females on college campuses and that when women say “no” to sexual behavior, men do not believe them. This study utilized penile plethysmography to investigate male sexual arousal to rape myth scenarios in a college population. The scenarios portrayed a woman who said “no” to sexually coercive intercourse behavior by a male. Results indicated that a low level of social desirability, sexual fantasies involving group sexual activity, as well as hurting and being hurt by a partner were associated with greater levels of physiological responding to coercive stimuli. Supportive attitudes about rape showed no relationship with physiological responding, yet did correlate with the sexual fantasy of being hurt by a partner, which was itself related to increased sexual arousal to sexually coercive audio stimuli. © 1997 John Wiley & Sons, Inc. J Clin Psychol 53: 935–942, 1997     

Condom use and risk factors of inconsistent or low use of the condoms during heterosexual anal intercourse in sub-Saharan Africa: a scoping review

BackgroundAnal intercourse (AI) has been reported to be the riskiest among other sexual intercourses in spreading human immunodeficiency virus (HIV) and the risk could be minimized by the use of condoms. Whilst AI is believed to be practised mainly by men who have sex with men, AI has also been reported to occur in heterosexual relationships. However, data on condom use during heterosexual AI are inadequate in sub-Saharan Africa.MethodA scoping review of English language published articles on condom use during heterosexual anal sex, whose studies were conducted in Sub-Saharan Africa from January 2010 to May 2020 was conducted. Articles were searched systematically on PubMed and Google Scholar electronic databases. Heterosexual AI was defined as penile penetrative anal sex between a man and a woman regardless of the sexual orientation of the 2 parties involved in the act of heterosexual AI.FindingsA total of 21 studies were eligible for analysis. Most of the studies (17 out of 21) reported females to be involved in heterosexual AI whilst 9 out of 21 studies reported males to be involved in heterosexual AI. The lifetime prevalence estimate of condom use during heterosexual AI ranged from 29%–97.5%. Other prevalence estimates of condom use during heterosexual anal intercourse were reported over various recall periods which were: 12 months'' recall period with prevalence estimates ranging from 2.9%–59%; prevalence estimates for the past 3 months which ranged from 50%–94.4%; 1 month''s recall period with prevalence estimates ranging from 5%–96% and prevalence estimates for the last intercourse experienced ranging from 1%–55%. Condom use during heterosexual AI was generally low and/or inconsistent among female sex workers (FSWs), men who have sex with men and women (MSMW) and some women in the general population. There were no risk factors identified in the study for the inconsistent or low use of condoms during heterosexual AI.ConclusionEvidence from this study suggests condom use during heterosexual AI could be fairly low especially among groups such as FSWs, MSMW and some women in the general population. Risk factors for using condoms inconsistently or using condoms less during heterosexual AI are not clear. Heterosexual anal intercourse and condom use during the AI practice is generally an under-studied subject in Sub-Saharan Africa. Future studies need to explore on heterosexual AI and condom use practices during AI comprehensively so that there can be concrete evidence on the subject which will inform targeted interventions aimed at reducing HIV among heterosexual populations in SSA.     

Associations between recent gender-based violence and pregnancy, sexually transmitted infections, condom use practices, and negotiation of sexual practices among HIV-positive women

BACKGROUND: This study sought to document the prevalence of recent gender-based violence (rGBV) among seropositive women and to determine the association between rGBV and pregnancy, sexually transmitted infections (STIs), condom use, and negotiation of sexual practices. METHODS: A total of 304 seropositive women recruited from HIV clinics in the southeastern United States who reported being sexually active in the previous 6 months with 1 partner were included in analyses. Gender-based violence during the previous 3 months, condom use, and negotiation of sexual practices were assessed. Biologic samples for pregnancy and STI testing were collected. RESULTS: A total of 10.2% of women reported a history of rGBV. rGBV was related to inconsistent condom use practices, pregnancy, and abuse stemming from requests for condom use. No associations were found between rGBV and negotiation of sexual practices and STIs. CONCLUSIONS: The prevalence of rGBV among HIV-positive women emphasizes the need for screening of abuse and highlights the need for the design and implementation of integrated intervention approaches necessary in addressing the needs of this population.     

The relation of alcohol use to HIV-risk sexual behavior among adults with a severe and persistent mental illness

The authors examined the relationship between alcohol use and HIV-risk sexual behavior and tested whether alcohol use immediately prior to sex is related to decreased condom use. The participants were 159 adults living with a severe and persistent mental illness. Each participated in a structured interview to assess all sexual and drug-use behavior over a 3-month period. Analysis of 3,026 sexual behaviors reported by 123 sexually active participants indicated that at the global level, participants who drank more heavily were more likely to have engaged in sexual risk behavior. At the event level, however, alcohol use was not related to condom use during vaginal or anal intercourse; that is, participants who used condoms when sober tended to use them to the same extent when drinking.     

Factors associated with regular episodes of dysuria among women in one rural general practice.

The aim of this study was to ascertain the factors associated with frequency-dysuria (urethral) syndrome in a population of women. The study included all women aged 25 years and over on 1 May 1987 who had been registered with one rural, dispensing practice over the study period, 1 May 1985 to 1 May 1989. A self-administered questionnaire was sent to the women on 1 May 1987 and a second, similar, questionnaire was sent two years later. A total of 721 women responded to the two questionnaires (response rate 97%). Regular symptoms of frequency and dysuria were reported by 8% of women in 1987 and 14% in 1989. Four percent of women reported symptoms throughout the four year study period. Symptoms were found to be least common in the 55-74 years age group. Although none of the women who were sexually inactive reported regular symptoms no association was reported between recent sexual intercourse and symptoms. Neither was an association demonstrated between type of contraception used and symptoms. However, it was found that premenopausal women reported significantly more symptoms than postmenopausal women. The number of women involved in this study was too small to allow the importance of change of sexual partner to be determined. Significantly more of the women who reported regular symptoms had been treated for urinary tract infection than of those who did not report regular symptoms. Although a history of regular frequency and dysuria points to a diagnosis of urethral syndrome, general practitioners must assess each case in order to exclude urinary tract infection.     

Sexual violence against adult women primary care attenders in east London.

BACKGROUND: Sexual violence against women is common. The prevalence appears to be higher in north America than Europe. However, not all surveys have differentiated the experience of forced sex by a current or former partner. Few women are thought to report these experiences to their general practitioner (GP). AIM: To measure the prevalence of rape, sexual assault, and forced sexual intercourse by a partner among women attending general practices, to test the association between these experiences of sexual violence and demographic factors, and to assess the acceptability to women of screening for sexual violence by GPs. DESIGN OF STUDY: Cross-sectional survey. METHOD: A self-administered questionnaire survey of 1207 women aged over 15 years was carried out in 13 general practices in Hackney, east London. RESULTS: Eight per cent (95% confidence interval [CI] = 6.2 to 9.6) of women have experienced rape, 9% (95% CI = 7.0 to 10.6) another type of sexual assault, and 16% (95% CI = 13.6 to 18.1) forced sex by a partner in adulthood: 24% (95% CI = 21.2 to 26.5) have experienced one or more of these types of sexual violence. Experiences of sexual violence demonstrated high levels of lifetime co-occurrence. Women forced to have sex by partners experienced the most severe forms of domestic violence. One in five women would object to routine questioning about being raped and/or sexually assaulted, and one in nine about being forced to have sex by a partner. CONCLUSION: Experiences of sexual violence are common in the lives of adult women in east London, and they represent a significant public health problem. Those women who have one experience appear to be at risk of being victims again. A substantial minority object to routine questions about sexual violence.     

'I did it for him, not for me': an exploratory study of factors influencing sexual debut among female university students in Durban, South Africa

We used qualitative interviews to explore the influences on first sexual intercourse among 10 young women who had sexual debut within a year of enrolling in the university. University culture of sexual permissiveness and pressure from sexually experienced friends and male partners were the main factors influencing sexual debut. Ambivalence and a range of coercive behaviours characterized first sex. Participants were unprepared for sex and lacked power in deciding the timing and circumstances of first sex resulting in physical and emotional pain and regret. Interventions should address the risks of first sex among students in institutions of higher learning.     

High prevalence of genital mycoplasmas among sexually active young adults with urethritis or cervicitis symptoms in La Crosse, Wisconsin

Sexually active young adults in the small college town of La Crosse, Wisconsin, were evaluated for conventional sexually transmitted pathogens and tested for infections with mycoplasmas. The prevalence in 65 symptomatic men or women and 137 healthy volunteers (67 men and 70 women) was compared. Urine specimens from both cohorts were tested by ligase chain reaction for Chlamydia trachomatis or Neisseria gonorrhoeae. In addition, the urethral or cervical swabs from the symptomatic subjects were tested by PCR for Mycoplasma genitalium and cultured for Mycoplasma hominis and the ureaplasmas. The results confirmed a relatively low prevalence of gonorrhea among symptomatic men (12%) and chlamydia among symptomatic men (15%) and normal women (3%). In contrast, infections with mycoplasmas, especially the ureaplasmas (57%), were common and the organisms were the only potential sexually transmitted pathogen detected in 40 (62%) symptomatic subjects. Because of the high prevalence, we also evaluated urethral swabs from an additional 25 normal female volunteers and recovered ureaplasmas from 4 (16%) subjects. Additionally, the participants rarely used protection during sexual intercourse and some symptomatic subjects apparently acquired their infections despite using condoms regularly. The findings demonstrate a strong association between abnormal urogenital findings and detection of myoplasmas, particularly ureaplasmas, and suggest the infections will remain common.     

Sexual lifestyle of women attending inner-city general practices for cervical smears.

Despite high prevalences of sexually transmitted infections, little is known about the sexual lifestyles of women attending inner-city general practices. Responses from a 1996 questionnaire showed that age at first intercourse and numbers of sexual partners were similar to the national survey five years earlier. However, only 49% of women reporting > or = 2 sexual partners in the past year said their partner had used a condom at the last sexual intercourse.     

HIV knowledge and risk factors among men who have sex with men in Ho Chi Minh City,Vietnam

OBJECTIVES: To describe health risk behavior, knowledge, and attitudes about HIV/AIDS and its prevention in men who have sex with men (MSM) in Ho Chi Minh City (HCMC), Vietnam. METHODS: A cross-sectional survey of 219 MSM using a standardized questionnaire. RESULTS: Men who have sex with men were easy to locate and willing to answer detailed questions about their sexual behavior. Self-identified sexual orientation was 67% homosexual, 31% bisexual, and 1.4% heterosexual. High-risk sexual behavior was common. The mean number of sexual partners was 3.3 in the previous month and 14.8 in the previous year. Only 32% used condoms during their last intercourse, and only 40% used a condom when their last intercourse included anal sex. Eighty-one percent reported sex with nonregular male partners, and 22% also had sex with women in the past year. Drug use other than alcohol was rare. Most correctly identified high-risk sexual behavior and body fluids that could transmit HIV; however, only about half knew that someone who appeared healthy could transmit HIV or that there was no cure for AIDS. Self-rated risk for HIV was very low, and fewer than one third believed that homosexuals in Vietnam are at increased risk for HIV. CONCLUSION: Men who have sex with men in HCMC are at high risk for HIV. Knowledge about HIV transmission and prevention could be improved. Education and interventions specifically aimed at MSM are needed, because education targeted at the general population may not reach MSM or influence their behavior.