Individual and familial influences on the onset of sexual intercourse among urban African American adolescents

A sample of 198 African American families, living in urban poverty, participated in a longitudinal study of adolescent sexual development beginning when children were in the 4th or 5th grade. Self-reports of family conflict and pubertal development and videotaped family interaction data were collected at 2 time points approximately 2 years apart. Youths reported on sexual debut at each time point. More boys than girls reached sexual debut early. Greater levels of family conflict predicted early sexual debut. Observational data indicated more developed preadolescents with greater family conflict and less positive affect were least likely to delay debut. Changes in pubertal development and observed family conflict were associated with early debut. Possible mediating mechanisms and implications for preventive interventions are discussed.     

Extramarital sex among Nigerian men: polygyny and other risk factors

The AIDS epidemic in Nigeria is generalized, with infection primarily occurring through heterosexual transmission. It is important to understand patterns of sexual behavior to assess their impact on the epidemic and to design appropriate intervention strategies. This study examined risk factors for extramarital sex among Nigerian men, with a particular focus on polygyny and peri- and postpartum abstinence. Data from the 2003 Nigeria Demographic and Health Survey were analyzed for 1153 men and their wives. Eleven percent of men reported extramarital sex in the previous year. Logistic regression models showed that men with 3 or more wives were at the greatest risk for extramarital sex, followed by monogamous men, when compared with men with 2 wives. Other significant predictors included region, religion, wealth, age at sexual debut, and self-perceived risk of HIV infection. Peri- and postpartum abstinence was not significant. Based on these findings, HIV prevention programs should include men with 3 or more wives and those living in the southwest region, in addition to activities targeting men of all ages. Given the heterogeneity within Nigeria, further in-depth studies should be undertaken to explore the relation between number of wives, peri- and postpartum abstinence, and extramarital sex within specific communities.     

Sexual behaviors and other HIV risk factors in circumcised and uncircumcised men in Uganda

OBJECTIVE: To study the differences in sexual practices, hygienic behaviors, and other HIV risk factors between circumcised and uncircumcised men. DESIGN: A cross-sectional study of men >17 years of age selected by single stage cluster sampling in the Industrial Borough, Mbale, Uganda. METHODS: Using a structured questionnaire, 188 circumcised and 177 uncircumcised consenting Ugandan men were interviewed in one of four native languages during April and May, 1997. RESULTS: Among non-Muslims, circumcised men had a higher risk profile than uncircumcised men in that they were more likely to drink alcohol in conjunction with sex (odds ratio [OR], 1.86: 95% confidence interval [CI], 1.09-3.16), to have sexual contacts with women on the first day of meeting (OR, 2.37; 95% CI, 1.39-4.04), to have had sexual contacts in exchange for money or gifts (OR, 2.08; 95% CI, 1.21-3.09), to have experienced episodes of pain on urination or to have experienced penile discharge (OR, 1.68; 95% CI, 1.07-2.64), had an earlier age at sexual debut (15.7 versus 16.9 years), and had more extramarital sex partners in the last year (1.13 versus 0.62). Circumcised men also reported a preference for nonwet sex. Muslims generally had a lower risk profile than other circumcised men except they were less likely to have ever used a condom (OR, 0.34; 95% CI, 0.15-0.78) or to have used a condom during the last sex encounter (OR, 0.37; 95% CI, 0.14-0.87). CONCLUSIONS: These results suggest that differences between circumcised and uncircumcised men in their sex practices and hygienic behaviors do not account for the higher risk of HIV infection found among uncircumcised men. Further consideration should be given to male circumcision as a prevention strategy in areas of high prevalence of HIV and other sexually transmitted diseases. Studies of the feasibility and acceptability of male circumcision in traditionally noncircumcising societies are warranted.     

Male circumcision in Siaya and Bondo Districts, Kenya: prospective cohort study to assess behavioral disinhibition following circumcision

BACKGROUND: Evidence for efficacy of male circumcision as an HIV prevention measure is increasing, but there is serious concern that men who are circumcised may subsequently adopt more risky sexual behaviors. METHODS: Using a prospective cohort study, we compared sexual behaviors of 324 recently circumcised and 324 uncircumcised men at 1, 3, 6, 9, and 12 months after circumcision/study enrollment. The main outcome indicators were incidence of sexual behaviors known to place men at increased risk of acquiring HIV, namely, having sex with partners other than their wife/wives for married men or other than "regular" girlfriends for unmarried men. RESULTS: During the first month following circumcision, men were 63% and 61% less likely to report having 0 to 0.5 and >0.5 risky sex acts/week, respectively, than men who remained uncircumcised. This difference disappeared during the remainder of follow-up, with no excess of reported risky sex acts among circumcised men. Similar results were observed for risky unprotected sex acts, number of risky sex partners, and condom use. DISCUSSION: During the first year post-circumcision, men did not engage in more risky sexual behaviors than uncircumcised men, suggesting that any protective effect of male circumcision on HIV acquisition is unlikely to be offset by an adverse behavioral impact.     

Early initiation of sex,drug-related risk behaviors,and sensation-seeking among urban,low-income African-American adolescents

The purpose of this study was to examine the relationship of early initiation of sex, drug-use, drug-trafficking, and sensation-seeking among urban, African-American adolescents. A longitudinal follow-up of 383 youth ages 9 to 15 years at baseline over four years with serial risk-assessments was used. Sexual experience and several drug-related risk behaviors increased significantly during the four-year study interval. Sensation-seeking scores were higher after the baseline assessment among youth reporting tobacco, alcohol, and marijuana use and were higher, both at baseline and through several follow-up assessments, among youth reporting drug-selling and sexual activity. At baseline, the correlations among drug-related risk behaviors were all strong, except those between initiation of sex and drug-related risk behaviors. However, over time, early initiators of sex were significantly more likely to report involvement in substance use and drug-delivery/sales than were late initiators. Youth reporting repeated involvement in drug-related activities were more likely to report intensive sexual involvement than they were to report experimental sex or no sex. Sensation-seeking scores were lower among youth reporting no involvement in risk behaviors. However, scores did not differ between youth exhibiting experimental behavior compared to youth demonstrating repeated risk involvement. These results support the need for alternative experiences for youth exhibiting high levels of sensation-seeking and the need for early drug/sexual risk prevention programs.     

Focus group interviews with risk-taking gay men: appraisal of AIDS prevention activities,explanations for sexual risk-taking,and needs for support

Recently, several findings demonstrated an increase in high-risk sexual behaviour among gay men. This study conducted focus groups with gay men who engaged in'risk-taking behaviour with casual partners. Three issues were addressed: appraisal of current AIDS prevention activities, explanations for sexual risk-taking, and needs for support. The results show that participants criticize current prevention efforts. The explanations for risk-taking behaviour contribute to a better understanding of the underlying processes related to sexual risk-taking. Participants' needs include unequivocal information on HIV and AIDS, more insight into the rationality behind safe sex directives, and more opportunities to discuss their difficulties regarding safe sex behaviour with peers.     

Sexual risk reduction in a cohort of injecting drug users in Bangkok, Thailand

OBJECTIVE: Interventions to reduce sexual risk behavior among injecting drug users (IDUs) have generally had very modest effects, but almost all such interventions have been conducted within short time frames. This study assessed whether long-term participation in interventions to reduce sexual risk behavior was associated with reduced sexual risk behavior. METHODS: A total of 806 IDUs participated in the Bangkok HIV Vaccine Trial Preparatory Cohort Study from 1995-1998 and remained in the study for at least 4 follow-up visits (approximately 16 months). Participants received HIV counseling and testing every 4 months and free condoms were provided. Structured interviews including questions on sexual behavior were administered every 4 months. RESULTS: Approximately 40% of participants reported engaging in unprotected sex (vaginal intercourse without always using a condom) with a regular partner at each study visit, without any decline over time in this behavior. There were declines in the proportions of participants reporting unprotected sex with casual partners and with paid partners (men only) over time, but the declines were confined to the early period of the study. Unprotected sex with casual partners was associated with amphetamine use. Condom use increased substantially among participants who seroconverted for HIV during the study. CONCLUSIONS: Interventions to reduce sexual risk behavior among HIV-seronegative IDUs over extended periods were no more likely to be effective than shorter interventions. New programs are needed to reduce sexual risk behavior among amphetamine users and among IDUs who are currently seronegative but are engaging in injection risk behaviors and in unprotected sex with regular partners.     

Childhood and adolescent sexual abuse and subsequent sexual risk behavior: evidence from controlled studies, methodological critique, and suggestions for research

Childhood and adolescent sexual abuse (CSA) is associated with a wide variety of adverse psychological and health outcomes, including negative sexual health outcomes. In this paper, we review the literature investigating the relation between CSA and subsequent sexual risk behaviors among men and women. Previous research has found a relatively consistent association between CSA and higher rates of sexual risk behaviors, particularly sex trading, more sexual partners, and an earlier age of first intercourse. However, there are a number of limitations to this research, including lack of a consistent definition of CSA, failure to investigate gender as a moderator, and possible confounding of the CSA experience with some of the sexual behavior outcome variables. Further, although there appears to be an association between CSA and later sexual risk behavior, researchers have not established whether this association is causal. Suggestions for future research and implications for clinical practice are discussed.     

Sex, sex role identification, and college students' projective drawings

A study of 109 undergraduates found that sex and sex role identification, as assessed by the Bem Sex Role Inventory (BSRI), were related significantly to sex sequence, sexual differences, and quality of drawing on the Draw-A-Person (DAP). Specifically, males and masculine persons tended to draw males first, female and feminine persons tended to draw females first, and androgynous persons were equally likely to draw a male or a female first. The greater the sexual differentiation of the female human figure drawing, the lower the subject's degree of masculinity. The single best predictor for identifying a female subject was the quality of the female figure drawing. Results were consistent with Machover's hypothesis that drawings of the human figure reveal facets of the subject's self-image.     

Gender-based violence, alcohol use, and sexual risk among female patrons of drinking venues in Cape Town, South Africa

Gender-based violence is a well-recognized risk factor for HIV infection among women. Alcohol use is associated with both gender-based violence and sexual risk behavior, but has not been examined as a correlate of both in a context of both high HIV risk and hazardous drinking. The purpose of this paper is to examine the association between recent abuse by a sex partner with alcohol and sexual risk behavior among female patrons of alcohol serving venues in South Africa. Specifically, the aim of this study is to determine whether sexual risk behaviors are associated with gender-based violence after controlling for levels of alcohol use. We surveyed 1,388 women attending informal drinking establishments in Cape Town, South Africa to assess recent history of gender-based violence, drinking, and sexual risk behaviors. Gender-based violence was associated with both drinking and sexual risk behaviors after controlling for demographics among the women. A hierarchical logistic regression analysis showed that after controlling for alcohol use sexual risk behavior remained significantly associated with gender-based violence, particularly with meeting a new sex partner at the bar, recent STI diagnosis, and engaging in transactional sex, but not protected intercourse or number of partners. In South Africa where heavy drinking is prevalent women may be at particular risk of physical abuse from intimate partners as well as higher sexual risk. Interventions that aim to reduce gender-based violence and sexual risk behaviors must directly work to reduce drinking behavior.     

柳州市不同层次暗娼人群梅毒及艾滋病感染状况分析

目的了解柳州市不同层次商业性工作者人群特征、艾滋病相关知识、行为及梅毒、艾滋病病毒感染等现状。方法采用二阶段整群抽样方法抽取调查对象,使用健康问卷面对面调查并采集血样检测HIV和梅毒抗体。结果本次研究共调查403人,部分调查对象认为能够从表面区分艾滋病感染者,与客人发生性行为时安全套使用率较高,但与固定性伴安全套使用率很低。不同档次对象的年龄、婚姻和文化程度略有不同,安全套使用率也略有差别。调查者中1d接客最多20人,1周接客最多25人;首次性行为年龄最小12岁,首次商业性服务年龄最小14岁。58.50%的调查者最近1年患过性传播疾病。未发现HIV阳性者,但发现梅毒RPR初筛阳性者10人,阳性率为2.48%。结论在干预活动时应针对不同层次人群特点,对有配偶或固定性伴者应当加大干预力度和采取不同的策略促其使用安全套,以减少HIV进一步传播。     

Exploring unsafe sexual practices among truck drivers at Meerut District,India: a cross-sectional study

BackgroundDespite implementation of HIV prevention programmes for truck drivers in India, unsafe sex behavior among truck drivers has been documented.ObjectiveThe objective of this study was to assess knowledge about HIV Transmission and modes of prevention, pattern of condom use with high risk partners and explore the practice of unsafe sex and its risk factors among truck drivers.MethodsThis exploratory cross-sectional study design was conducted on a recruited convenient sample of 100 truck drivers above 18 years from March to May 2015. Binary logistic regression was used to compute unadjusted odds ratio [95% Confidence Interval] for establishing association of risk factors with unsafe sex.ResultsOverall, only 7% had complete knowledge about HIV/AIDS transmission and prevention. 54% of truck drivers have sex with a high risk partner (commercial sexual worker or men having sex with men) and thirty-eight percent reported unsafe sexual practices due to inconsistent condom use with them. The various risk factors found significantly associated with unsafe sex were mean age of first intercourse (OR= 0.92, 95% CI: 0.75 – 0.97), access to pornography (OR = 4.4, 95% CI: 1.8 – 10.7) and conuming psychoactive substance before sex (OR = 4.06, 95% CI: 1.09 – 15.02).ConclusionSocio-demographic, occupational factors, pornography access and consuming psychoactive substances seems to influence the sexual behaviour of truckers.     

Correlates of national HIV seroprevalence: an ecologic analysis of 122 developing countries

BACKGROUND: Ecologic analyses of social and developmental correlates of country-level HIV seroprevalence may suggest strategies for combating the HIV/AIDS epidemic. METHODS: Regression analyses were performed for 81 variables obtained primarily from United Nation agencies for 122 developing countries. Variable measures were compared between highest and lowest tertiles of HIV seroprevalence. RESULTS: Geography, religion, and income inequality were independently associated with HIV seroprevalence. Countries with earlier ages at first sex, higher teenage birth rates, and higher fertility rates had higher HIV seroprevalence. Countries with high HIV seroprevalence had fewer women using contraceptives, more persons with casual sex partners, and higher herpes simplex virus 2 seroprevalence. Male circumcision and Muslim religion were colinearly associated with lower HIV seroprevalence. Countries with high HIV seroprevalence had fewer doctors, more midwives, and less access to essential medications, but health spending differences were minor. CONCLUSIONS: Ecologic analyses support population-level behavioral approaches, such as delaying sexual debut and discouraging casual sex partners, and reinforce biologic measures, such as controlling sexually transmitted infections and promoting male circumcision, for HIV prevention. Fewer births attended by skilled personnel, but more midwives, in countries with the highest HIV seroprevalence suggest potential strategies for reducing mother-to-child transmission. Correlations with selected health indicators suggest additional obstacles for implementing HIV treatment programs.     

A survey of HIV infection and related high-risk factors among men who have sex with men in Suzhou,Jiangsu,China

A cross-sectional study using the snowball sampling method was conducted in May 2008 to investigate human immunodeficiency virus (HIV) infection status and related high risk factors among men who have sex with men (MSM) in Suzhou city of Jiangsu province. The researchers carried out a face-to-face questionnaire interview among MSM, and collected their blood samples to test for HIV and other sexually transmitted diseases (STDs). Among the 280 respondents, 91.1% had homosexual acts in the past 6 months and 87.5% had multiple homosexual partners; 46.4% had heterosexual sex in the past 6 months and 33.1% had multiple heterosexual partners. The rate of continued condom use was 44.3% in homosexual sex in the past 6 months, while the rate in heterosexual sex was 33.9%. Laboratory test results showed that the prevalences of HIV and syphilis were 7.1% (20/280) and 15.0% (42/280), respectively, but no HCV-positive person was found. In the multivariate logistic regression model, subjects with a monthly income of more than RMB $ 1,000 (OR=4.83,95% CI=1.44-16.22), subjects who often went to bars for sexual partners (OR=2.25, 95%CI=1.21-4.20), and subjects who had more than one sexual partner in the past 6 months (OR=0.49, 95%CI=0.25-0.97) and had sex with fixed sexual partners in the past 6 months (OR=0.42, 95%CI=0.25-0.75) were significantly associated with the rate of continued condom use in homosexual sex in the past 6 months. Unprotected sex and multiple sexual partners were more common among MSM in Suzhou city; furthermore, the prevalences of HIV infection and syphilis were relatively high. HIV preventive measures should be designed to address these risk factors and control the spread of HIV among MSM.     

Sexual behavior among injection drug users in 3 indonesian cities carries a high potential for HIV spread to noninjectors

OBJECTIVE: To establish the prevalence of injecting practices that carry a risk of HIV infection among injection drug users (IDUs) in Indonesia and to examine the risk of sexual transmission of HIV from IDUs to noninjecting populations. DESIGN: A first round of behavioral surveillance among community-recruited male IDUs in 3 cities. METHODS: In late 2002, IDU gathering places were mapped in 3 cities, and 650 IDUs were recruited using multiple wave sampling originating from sites systematically selected for diversity. Trained interviewers, mostly former IDUs, administered a questionnaire focusing on injecting practices, sexual behavior, and HIV-related knowledge. RESULTS: Almost all IDUs knew that HIV is transmissible through shared needles, but 85% of injectors reported using a syringe previously used by another IDU in the previous week. Over two thirds of IDUs were sexually active, 48% reported multiple partners, and 40% had bought sex from a female sex worker in the preceding 12 months. Consistent condom use was reported by 10%. CONCLUSIONS: The potential for the sexual spread of HIV from IDUs to noninjectors is extremely high in Indonesia. Interventions are urgently needed to reduce high levels of needle sharing, but a focus on needle cleaning and increasing condom use among IDUs is also essential.     

Determinants for having sex while symptomatic among patients with sexually transmitted infections in Uganda

In order to identify predictors of having sex while symptomatic among patients with sexually transmitted infections (STIs), a cross-sectional study was done at Mulago STD clinic in Kampala, Uganda. Ninety eight patients with STIs who engaged in sex while symptomatic were compared with 40 patients who did not engage in sex while symptomatic on: social-demographic; STI symptoms, health seeking behavior; condom use, sexual behaviour; partner referral; and knowledge and attitudes about STIs. On univariate analysis the risk of having sex while symptomatic was increased by: being female (crude odds ratio (COR) 2.82,95% confidence interval (CI) 1.24-6.47), being married (COR 4.42, CI 1.89-10.43); presenting with other symptoms apart form vaginal / urethral discharge, genital ulcer, or low abdominal pain (COR 2.76, CI1.19-6.41); having a regular partner (COR3.14, 1.49-7.83); not having sex with a casual partner (COR 3.86 CI 1.46-10.29), and finding it difficult to refer sexual partners (COR 2.66, CI 1.04-6.86). The independent predictors of having sex while symptomatic were symptoms > 14 days duration (adjusted odds ratio (AOR) 8.01, CI 2.00-16.67), previous medications (AOR 5.85, CI 2.04-16.75) and finding it difficult to refer sexual partners (AOR 4.76, CI 1.45-16.67). To reduce the proportion of STI patients who engage in sex while symptomatic, there is need to strengthen health education messages that stress the importance of abstaining from sex while symptomatic and to provide effective treatment at the first level of contact with these patients.     

Alcohol use and contraception in first sexual experiences

Recent research has suggested that the use of alcohol or drugs in conjunction with sexual intercourse is associated with nonuse of contraception, particularly in first intercourse experiences. This paper reports findings from a nationally representative sample of adolescents and young adults aged 18–30 who were asked a number of questions about the circumstances and characteristics of the first time they had intercourse. Results showed that drinking at the time of first intercourse was more prevalent among those who first had sex prior to 1985; moreover, members of this cohort were less likely to use condoms or other forms of birth control at the time of first intercourse. Drinking was associated with nonuse of contraception only among those who had their first sexual experience prior to 1985. The results are discussed in terms of historical changes in the sexual climate of the AIDS era.This research was supported by Grant AA085464 from the National Institute on Alcohol Abuse and Alcoholism.     

Reproductive health perceptions,beliefs and sexual risk-taking among youth in Addis Ababa,Ethiopia

Appropriate knowledge and beliefs about sexuality and necessary life skills do not often precede sexual behaviours among young people. This study outlines a profile of sexual risk factors and the underlying sexual and reproductive health perception and beliefs among youth (aged 15-24 years) in Addis Ababa, Ethiopia. Five hundred and sixty-one youth residing in two of the six zones of Addis Ababa filled a self-administered questionnaire. Three outcome variables: history of sexual activity in the past, use of condom during recent sexual intercourse and use of alcohol, were used to construct a pyramid of sexual risk categories. Being a female, age group of 20-24 years and out-of-school significantly increased the likelihood of belonging to the most vulnerable category. Although young people were heterogeneous in their sexual risk-taking, they were equally uninformed on reproductive health matters related to puberty and sexuality. Their respective beliefs also tended to be flexible and unstable to consistently predict their behaviour. Possible reasons for such heterogeneity and its practical implications in sex education strategies are discussed.