Predictors of condom use among sexually active persons involved in compulsory national service in Ibadan, Nigeria

Migration is known to increase the risk of heterosexual transmission of human immunodeficiency virus (HIV) in sub-Saharan Africa, but little attention has been paid to fresh graduates of tertiary institutions who are on migration for compulsory national assignment in Nigeria. In July and August 2004, a survey was conducted on sexually active men (n = 344) and women (n = 373) to investigate determinants of condom use during national service. Sixty-eight percent of men and 41% of women reported condom use at last intercourse before the survey. For both men and women, condom use was common if they had one or more regular sex partners and if they were purchasing condoms. In addition, women's condom use was predicted by being single and having intention to use condoms in next intercourse. The findings further showed that there was high risk of HIV transmission in the sample population as consistent condom use was 15% for men and 4% for women. Twelve percent of men and 8% of women reported STI diagnoses in the last 12 months before the survey. Four percent of men and 2% of women reported they already had HIV diagnoses. Only 1% of men and 2% of women reported they would receive voluntary HIV test if offered free by the government. The study findings suggest the need to extend the existing condom social marketing services in the country to the youth on national service and promote condom education messages among them prior to commencing national service.     

Gender differences in clinical manifestations before AIDS diagnosis among injecting drug users

We compared incidence rates of self-reported HIV-related symptoms and illnesses, verified clinical manifestations and findings on physical examination between female and male injecting drug users (IDU) stratified by HIV serostatus in the Amsterdam cohort study on the natural history of HIV infection. HIV-positive female IDU (n = 100) reported a higher frequency of several symptoms and illnesses than male IDU (n = 139). Symptoms were reported more chronically by women compared to men, while clinical manifestations were reported by a greater proportion of women affected by these illnesses compared to men. In HIV-negative IDU (163 women and 232 men) the incidence rates were lower compared to HIV-positives, and a similar gender effect on reported symptoms and illnesses was found. Adjusting for biological, behavioral, demographic and study related variables did not change the gender effect on clinical manifestations substantially. We conclude that the gender effect among HIV-positive IDU was not caused by a differential impact of HIV infection on the incidence of the studied clinical manifestations among female and male IDU, but reflects a higher morbidity of female IDU compared to male IDU.     

Blood lipid and lipoprotein levels: relationships with educational level and region of residence in the French SU.VI.MAX study

BACKGROUND: Blood lipid profile of French men and women obtained from the general population is not well known. Furthermore, the association between these lipids, as a function of other potential risk factors for cardiovascular disease, and sociodemographic factors such as age, educational level, and region of residence is not well studied in large samples in Europe. METHODS: Data on French healthy volunteers, aged between 40 and 65 years for men (n = 5141) and 35 and 65 years for women (n = 7876) were obtained from the "Supplementation en Vitamines et Mineraux Antioxydants" (SU.VI.MAX) study, a primary prevention trial. Baseline blood samples were collected in 1994-1995 and analyzed for cholesterol, triglyceride, apolipoproteins (apo)-B and -A1. The results were analyzed separately for men and women as a function of age, educational level, and area of residence. RESULTS: Overall, blood lipid levels for men and women did not differ significantly from those reported in other Western industrialized countries. Except for triglyceride in men, all blood lipids were statistically different among ages. In women, cholesterol, apo-A1, and apo-B showed a significant decrease with educational level. Statistical differences were found in both genders between blood lipids and lipoproteins among regions of residence. CONCLUSIONS: Even if differences between region of residence were found in blood lipid levels, this cannot explain the North-East to South gradient in the prevalence of cardiovascular disease in France nor differences between France and other industrialized Western countries.     

Sexual Risk Behaviors of HIV-Positive,HIV-Negative,and Serostatus-Unknown Black Men Who Have Sex with Men and Women

Black men who have sex with men and women (MSMW) are at high risk for HIV infection and transmission. This study compared the sexual risk behaviors of Black MSMW who self-reported being HIV-positive with those who reported being HIV-negative and those who did not know their HIV status. Respondent-driven sampling (RDS) was used to recruit 1,154 Black MSM in Philadelphia and New York who completed an audio computer-assisted self-interview (ACASI). Of these men, 212 had engaged in anal sex with male partners and vaginal or anal sex with female partners in the past 3 months. A quarter (23.6%; n = 50) of MSMW self-reported testing positive for HIV at their last test, 59.4% (n = 126) reported testing negative for HIV at their last test, and 17.0% (n = 36) reported never having an HIV test. Multivariate logistic regression analysis revealed that HIV-positive MSMW were much less likely than HIV-negative men and never-tested men to have engaged in unprotected intercourse with main male and main female partners perceived to be HIV-negative or of unknown serostatus. However, HIV-positive men were equally as likely as HIV-negative men to have unprotected intercourse with non-main male and non-main female partners perceived as HIV-negative or of unknown serostatus. Our findings indicate that some HIV-positive MSMW engage in unprotected sex that places female and male partners at risk for HIV infection. However, MSMW who have never taken an HIV test, or who have not been recently tested, may be a greater source of HIV transmission to their female and male partners.     

Factors associated with nonuse of condoms in heterosexual men and women attending an HIV testing clinic in Israel.

OBJECTIVES: To examine gender differences in HIV-related knowledge, perceived vulnerability, beliefs in self-control, type of sexual partnership, and their associations with nonuse of condoms. METHODS: Heterosexual men and women who voluntarily attended an HIV testing clinic in Israel were asked to complete a self-report questionnaire. Scales of HIV knowledge and control and a single item for vulnerability were used. Type of sexual relationship (monogamous vs. nonmonogramous) and condom use in vaginal sex (never vs. ever) referred to the previous 6 months. Response rate was 84%; 154 men and 109 women participated. RESULTS: Beliefs in self-control did not form a reliable scale and single items were used. No statistically significant gender differences were found in knowledge, vulnerability, or beliefs in self-control. Levels of correct HIV-related knowledge were high, but so were some misconceptions. The vast majority (87%) perceived themselves as vulnerable to HIV infection. The beliefs in self-control were moderate in some items, and low in others. In logistic regression models, different factors were significantly associated with nonuse of condoms in the two genders: the belief that their lifestyle protected them against HIV infection (OR = 2.72, CI = 1.06-7.03) among men, and being monogamous (OR = 3.72, CI = 1.28-10.8) among women. CONCLUSION: Heterosexual men and women attending an HIV testing clinic need counseling to further lower misconceptions about HIV transmission and additional gender-specific counseling to address HIV-related beliefs.     

Vulnerability to HIV/AIDS in married heterosexual people or people in a common-law marriage

OBJECTIVE: To study knowledge, preventive behavior, and perception regarding HIV/AIDS of heterosexual men and women that are married or in a common-law marriage. METHODS: Exploratory study carried out in the Federal District of Brazil, between 2001 and 2002. Heterosexual men and women (N=200) aged 18 and 49, married or in a common-law marriage were divided into two groups: (I) 50 couples approached in public places, and (II) 100 users of a Basic Health Unit, 50 were women and 50 were men. The instrument for data collection was a semi-structured questionnaire on demographic, socioeconomic and behavioral characteristics of the interviewees, with 38 questions, two of which were open. RESULTS: The age distribution between the groups was similar, but group I had a higher level of schooling and income, while group II had less knowledge about the ways that HIV is transmitted. The use of condoms was equally mentioned by both groups as one of the types of prevention. Of the interviewees, 14% reported its regular use in the last year. The main reasons for not using condoms were "trusting the partner" and "being incompatible with having a fixed partner". The perception of the risk of infection was more frequent among women. CONCLUSIONS: The population studied was vulnerable to the risk of getting the disease, although the interviewees had enough knowledge on HIV/AIDS. Their perceptions of the couple reflected their acculturation in relation to gender roles and the hierarchization of the affective-sexual relationship, which can contribute to the small adoption of preventive behavior.     

Extrarelational sex among Mexican men and their partners' risk of HIV and other sexually transmitted diseases

OBJECTIVES: This study explored the risk of HIV and other sexually transmitted diseases (STDs) among married and cohabiting women in Mexico City, Mexico, derived from their partners' sexual behaviors. METHODS: Results were derived from the first population-based household survey in Mexico that investigated male sexual behavior. Analyses were restricted to sexually active married or cohabiting men (n = 3990). RESULTS: Fifteen percent of the men reported extrarelational sex during the past year, 9% reported condom use during last intercourse, and 80% perceived no HIV risk. Most secondary partners were coworkers, mistresses, or friends. CONCLUSIONS: Targeted HIV and STD prevention efforts appear necessary because a substantial number of women may be at risk.     

Gender differences in posttraumatic stress symptoms and social support in a sample of HIV-positive individuals

The aim of the authors of the present study was to investigate gender differences in the levels of posttraumatic stress symptoms (PTSS) and social support in a Polish sample of HIV+ men (n = 613) and women (n = 230). This was an anonymous cross-sectional study, and participation was voluntary. The research questionnaires were distributed in paper form among patients of Warsaw’s Hospital for Infectious Diseases from January to October 2015. The level of PTSS was assessed using the PTSD Factorial Version Inventory. Social support was assessed using the Berlin Social Support Scales. HIV+ women scored higher on all PTSS dimensions compared to HIV+ men. HIV+ women were characterized by a higher need for support and more support actually received compared to HIV+ men. We observed a positive association between HIV infection duration and AIDS phase and the global trauma score only among HIV+ men. The moderation analysis also revealed a positive relationship between actual received support and the global trauma score among HIV+ women only. Increased clinician awareness is needed about the role of PTSS and social support among people living with HIV, especially taking gender differences into account.     

Post-Traumatic Stress Disorder and HIV: A Snapshot of Co-Occurrence

Although the medical advances in the area of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) have undoubtedly improved the length and quality of life for those who are HIV-affected and medication adherent, there are still many psychosocial obstacles to effective HIV/AIDS medication adherence. Recent research has focused on one such obstacle. The significant link between post-traumatic stress disorder (PTSD) and HIV. This article reports on the nature of this relationship with a cross-sectional study of active clients (n = 186) who were receiving HIV services from community-based settings in the New York City area. With the use of the PTSD Checklist (PCL), this study determined that more than half of the sample tested positively for PTSD. Policy and clinical implications of this and other findings are discussed.     

Women's experience of traumatic stress in cancer treatment

In this study we investigated gender differences in the prevalence and predictors of posttraumatic stress disorder (PTSD) in a sample of cancer patients. Eighty-seven patients (59 women and 28 men) recruited from a local cancer clinic completed measures of individual coping style, social support resources, symptoms of PTSD, and the nature of the trauma associated with these symptoms. PTSD symptoms were more frequently reported by women (27% versus 10%). Predictors of PTSD for women were (1) perceived intensity of cancer treatment; (2) problems with health care professionals; (3) and cognitive avoidant coping style. For men, the sole predictor of elevated PTSD scores was behavioral avoidance. Women reported significantly higher levels of treatment intensity (TI), greater numbers and types of treatment, and more problems with health care professionals. Interpersonal and relational aspects of their illness were reported as most stressful, compared with men who were more concerned with work and finances. These differences may, in part, reflect an androcentric model of cancer treatment, which women experience as particularly stressful.     

Trends in mortality from pulmonary tuberculosis and HIV/AIDS co-infection in rural South Africa (Agincourt)

This study investigates trends and age-and-sex patterns of mortality in pulmonary tuberculosis (PTB) and PTB/HIV co-infection in a rural population of South Africa. The PTB/HIV mortality emerged in 1994, and has been rising ever since (men: P=0.001; women: P=0.020, test for trend). In the last 2 years, for both sexes combined, 63% (95% CI 51-74%) of PTB deaths were attributable to HIV/AIDS. PTB/HIV death rate was higher in men than in women for all ages combined (RR(MH)=2.48, 95% CI 1.53-4.04, P<0.001). PTB/HIV death rate was also higher in younger individuals (<25 years) compared with PTB without HIV/AIDS (P=0.033), and the median age at death from PTB/HIV in women (28 years) was lower than in men (38 years, P=0.002). While mortality from PTB without HIV remained constant over time, HIV/AIDS explained the rise in PTB mortality. In the last 3 years, the HIV/AIDS epidemic has caused the number of persons dying of PTB to increase by +117%, with the mortality excess being higher in women (+164%) than in men (+103%, P=0.001). Combined PTB and HIV programme activities need to be reinforced to respond to the increase in PTB mortality, particularly in women.     

The female condom: attitudes and experiences among HIV-positive heterosexual women and men

The female condom is a potentially effective method for the prevention of HIV, other sexually transmitted disease, and pregnancy. This study describes attitudes toward and experiences with the female condom of 89 HIV-positive individuals (n = 56 women; n = 33 men) reporting heterosexual behavior. Qualitative interviews were conducted to inform the design and implementation of a cognitive-behavioral risk-reduction and health-promotion intervention. Most respondents (n = 78) had seen or heard of the female condom. However, relatively few (n = 14 women; n = 5 men) had used it at least once. Reactions from both women and men across user groups, regardless of favorable or unfavorable attitude or experience with the female condom, centered around a similar set of factors: aesthetics, difficulties with the male condom, male partner reaction, beliefs about efficacy, and lack of training. These findings underscore the need for additional research and comprehensive education efforts aimed at both technical use and communication skills-building in order to realize the potential of the female condom as an alternative barrier method.     

Gender-specific Correlates of Sex Trade among Homeless and Marginally Housed Individuals in San Francisco

Objective: Sex exchange is a well-established risk factor for HIV infection. Little is known about how correlates of sex trade differ by biologic sex and whether length of homelessness is associated with sex trade. We conducted a cross-sectional study among a sample of 1,148 homeless and marginally housed individuals in San Francisco to assess correlates of exchanging sex for money or drugs. Key independent variables included length of homelessness; use of crack, heroin or methamphetamine; HIV status; and sexual orientation. Analyses were restricted by biologic sex. In total, 39% of women and 30% of men reported a lifetime history of sex exchange. Methamphetamine use and greater length of homelessness were positively associated with a history of sex trade among women, while heroin use, recent mental health treatment, and homosexual or bisexual orientation were significantly associated with sex trade for men. Crack use was correlated with sex trade for both genders. Correlates of sex trade differ significantly according to biologic sex, and these differences should be considered in the design of effective HIV prevention programs. Our findings highlight the critical need to develop long-term services to improve housing status for homeless women, mental health services for homeless men, and drug treatment services for homeless adults involved in sex work.Weiser, Dilworth, and Neilands are with the Center for AIDS Prevention Studies, University of California, San Francisco (UCSF), San Francisco, CA, USA. Cohen, Bangsberg, and Riley are with Epidemiology and Prevention Interventions (EPI) Center, Division of Infectious Diseases, San Francisco General Hospital, UCSF; Bangsberg is with the Positive Health Program, San Francisco General Hospital, UCSF.The Epidemiology and Prevention Interventions Center, Positive Health Program and Center for AIDS Prevention Studies are programs of the UCSF AIDS Research Institute.     

Prior assault and posttraumatic stress disorder after combat deployment

BACKGROUND: Factors that make people vulnerable to or resilient against posttraumatic stress disorder (PTSD) following overwhelming stress are not well understood. The objective of this study was to prospectively examine the relation between prior assault and new-onset PTSD symptoms in a large US military cohort deployed in the wars in Iraq and Afghanistan. METHODS: Data on exposures and health outcomes were collected in the Millennium Cohort study at enrollment (July 2001 to June 2003) and follow-up (June 2004 to February 2006) from over 55,000 participants. Of these, 5324 were deployed in Iraq and Afghanistan, reported combat exposures, and were free of PTSD at baseline (881 women and 4443 men). We used multivariable logistic regression analysis to model the odds of new-onset PTSD in relation to prior assault. RESULTS: New-onset PTSD symptoms or diagnosis among deployers reporting combat exposures occurred in 22% of women who reported prior assault and 10% not reporting prior assault. Among men reporting prior assault, rates were 12% and 6%, respectively. Adjusting for baseline factors, the odds of new-onset PTSD symptoms was more than 2-fold higher in both women and men who reported assault prior to deployment. CONCLUSIONS: Prior assault appears to confer increased vulnerability for, rather than resilience against, PTSD symptoms among military professionals deployed to recent combat operations.     

Trends in leisure time and work-related physical activity in the Spanish working population, 1987-2006

Objective

To analyze time trends in the prevalence of leisure time (LTPA) and work-related (WRPA) physical activity between 1987 and 2006 in the Spanish working population.

Methods

We analyzed data taken from the Spanish National Health Surveys for 1987 (n = 29,647), 1993 (n = 20,707), 1995-1997 (n = 12,800), 2001 (n = 21,058), 2003 (n = 21,650), and 2006 (n = 29,478). The main variables were LTPA and WRPA in working adults aged 18-64 years old. We analyzed sociodemographic characteristics, self-perceived health status, lifestyle habits and associated comorbidities using multivariate logistic regression models.

Results

The prevalences of LTPA and WRPA were lower in women than in men (p < 0.05). The practice of LTPA (OR: 1.54, 95%CI: 1.32-1.80 for women; OR = 1.15, 95%CI: 1.02-1.31 for men) and WRPA (OR = 1.73, 95%CI: 1.38-2.19 for women; OR = 1.55, 95%CI: 1.44-1.91 for men) significantly increased from 1987 to 2006. In both genders, the variables associated with a higher likelihood of practicing LTPA were greater age, higher educational level and being an ex- or non-smoker, while negative predictors included being married, worse self-perceived health, and obesity. Factors that increased the probability of reporting WRPA were being married, worse self-rated health status, and sleeping > 8 h per day. The only factor that reduced the probability of reporting WRPA was being an ex- or non-smoker.

Conclusions

We found an increase in LTPA and WRPA in the last 20 years in the Spanish working population. Several factors were associated with a higher or lower likelihood of practicing LTPA or WRPA in this population.     

WOMEN'S EXPERIENCE OF TRAUMATIC STRESS IN CANCER TREATMENT

In this study we investigated gender differences in the prevalence and predictors of posttraumatic stress disorder (PTSD) in a sample of cancer patients. Eighty-seven patients (59 women and 28 men) recruited from a local cancer clinic completed measures of individual coping style, social support resources, symptoms of PTSD, and the nature of the trauma associated with these symptoms. PTSD symptoms were more frequently reported by women (27% versus 10%). Predictors of PTSD for women were (1) perceived intensity of cancer treatment; (2) problems with health care professionals; (3) and cognitive avoidant coping style. For men, the sole predictor of elevated PTSD scores was behavioral avoidance. Women reported significantly higher levels of treatment intensity (TI), greater numbers and types of treatment, and more problems with health care professionals. Interpersonal and relational aspects of their illness were reported as most stressful, compared with men who were more concerned with work and finances. These differences may, in part, reflect an androcentric model of cancer treatment, which women experience as particularly stressful.     

Production rates of cortisol in obesity

OBJECTIVE: To determine the metabolic clearance rates (MCRs) and endogenous production rates (PRs) of cortisol (F) in grades 2 and 3 obese men (n = 9) and women (n = 6). RESEARCH METHODS AND PROCEDURES: The MCRs and the endogenous PRs of cortisol (F) were determined in grades 2 and 3 obese men (n = 9) and women (n = 6) using the stable isotope dilution technique and mass spectrometry. RESULTS: In obese women, endogenous PRs of F (0.6 +/- 0.4 mg/h) were similar to those of nonobese women, but MCRs of F were higher in obese women (9 +/- 4 L/h) compared with nonobese women (5 + 2 L/h; p < 0.05). The MCR of F was correlated with the ratio of excreted cortisone to F metabolites. Furthermore, obese women were characterized by an increased ratio of androsterone to etiocholanolone (p < 0.01). In obese men, the MCRs (11 +/- 6 L/h) and the endogenous PRs of F (0.6 +/- 0.3 mg/h) were both similar to those of nonobese men, but the MCR of F was directly correlated with the ratio of excreted cortisone to F metabolites (r = 0.7833, p = 0.012). DISCUSSION: These data demonstrate sex-specific differences in F metabolism in obesity. The rise in MCRs of F is more pronounced in obese women than in men. However, the increase in the MCR of F is moderate in both genders and exceeds the normal range only in a subgroup of obese individuals.     

Sexual Risk Behaviors Among HIV-Positive Black Men Who Have Sex With Women, With Men, or With Men and Women: Implications for Intervention Development

Objectives. We compared demographics and sexual and drug risk behaviors among HIV-positive Black men who have sex with women only, with men only, or with men and women to assess differences among and between these groups.Methods. We analyzed cross-sectional data from the Supplement to HIV and AIDS Surveillance Project for 2038 HIV-positive Black men who reported being sexually active. We classified the participants by their reported sexual behaviors in the past year: intercourse with women (n = 1186), with men (n = 741), or with men and women (n = 111).Results. Respondents whose sexual partners were both men and women reported more noninjection drug use, sexual exchange, and sexual partners than did the other 2 groups. Bisexual respondents were also more likely than were heterosexuals to report unprotected intercourse with a steady female partner and were more likely than were both other groups to report having steady partners of unknown HIV serostatus and using drugs during their last sexual episode.Conclusions. HIV-positive Black men with both male and female sexual partners engaged in more sexual and drug risk behaviors than did their heterosexual and homosexual peers. More information concerning the prevention needs of behaviorally bisexual HIV-positive Black men is needed.Epidemiological studies consistently show that Black men are disproportionately affected by HIV/AIDS.¹ Although non-Hispanic Black men composed approximately 6% of the US population, they accounted for 29.2% of the estimated number of adults and adolescents living with HIV/AIDS at the end of 2005.^1,2 Surveillance data show that unprotected male–male sexual intercourse and injection drug use are the primary modes of HIV transmission among Black men. Behavioral studies examining sexual risk show that some HIV-positive persons, including HIV-positive Black men, continue to engage in unprotected sexual intercourse with male and female partners of negative and unknown HIV serostatus.^3–8Considerable research has examined sexual and drug risk behaviors, partner characteristics, and sociodemographics of HIV-positive men. Factors such as use of alcohol or drugs during last episode of sexual intercourse,^9–12 partnership status (steady or nonsteady),^13,14 number of partners,¹⁵ partner''s HIV status (negative, positive, or unknown),^16–18 poverty,¹⁹ and sexual exchange (paying or receiving goods or money for sexual intercourse)^20,21 have all been associated with high-risk sexual behaviors among HIV-positive persons. Many of these studies included relatively few Black men, or Black homosexual and bisexual men were combined into 1 group, or Black men were compared with high-risk men of other race/ethnicity. Although all of these studies have produced pieces of a puzzle for understanding issues associated with HIV transmission among Black men living with HIV/AIDS, they have not specifically focused on behaviorally different groups of HIV-positive Black men.Rates of HIV seropositivity are high among Black men, and HIV infections are spreading throughout Black communities. We therefore sought to examine differences in self-reported sexual behavior between HIV-positive Black men who have sex with men (MSM), with women (MSW), or with men and women (MSMW) without regard to self-reported sexual orientation. In particular, we examined differences in sexual risk behavior between MSW and MSMW and between MSM and MSMW in the past year. Our data may identify factors contributing to the spread of HIV in Black communities, assist researchers to develop interventions to reduce and eliminate high-risk behaviors in these populations, and ultimately help reduce and prevent the transmission of HIV.