参与式方法在学校艾滋病健康教育中的效果评估

目的评价参与式方法在学校艾滋病防治健康教育中的效果。方法在参与式教学前后采用相同问卷对昆明市一所中等医学专科学校267名二年级学生进行性病/艾滋病相关知识、态度对比调查。结果参与式教学前后:①艾滋病相关知识认知有变化,且差别有统计学意义(χ2=9.53,P<0.01);②性病知识认知变化大,差别有统计学意义(χ2=83.09,P<0.01);③艾滋相关态度有不同程度地改变,且差别有统计学意义(P<0.01)。结论参与式方法应用于课堂对学生的性病/艾滋病相关知识、相关态度作用明显,有利于学校更好地开展艾滋病健康教育。     

The estimated direct medical cost of sexually transmitted diseases among American youth, 2000

CONTEXT: Each year, millions of U.S. youth acquire sexually transmitted diseases (STDs). Estimates of the economic burden of STDs can help to quantify the impact of STDs on the nation's youth and on the payers of the cost of their medical care.
METHODS: We synthesized the existing literature on STD costs to estimate the lifetime medical cost per case of eight major STDs–HIV, human papillomavirus (HPV), genital herpes simplex virus type 2, hepatitis B, chlamydia, gonorrhea, trichomoniasis and syphilis. We then estimated the total burden of disease by multiplying these cost-per-case estimates by the approximate number of new cases of STDs acquired by youth aged 15–24.
RESULTS: The total estimated burden of the nine million new cases of these STDs that occurred among 15–24-yearolds in 2000 was $6.5 billion (in year 2000 dollars). Viral STDs accounted for 94% of the total burden ($6.2 billion), and nonviral STDs accounted for 6% of the total burden ($0.4 billion). HIV and HPV were by far the most costly STDs in terms of total estimated direct medical costs, accounting for 90% of the total burden ($5.9 billion).
CONCLUSIONS: The large number of infections acquired by persons aged 15–24 and the high cost per case of viral STDs, particularly HIV, create a substantial economic burden.     

Sex work and sex trafficking

Preventing HIV infection and other sexually transmitted diseases (STDs), as well as sexual and physical violence, are major occupational health and safety concerns for prostitutes. Considerable evidence shows that anti-prostitution laws facilitate violence and abuse against prostitutes and may increase their risk of contracting HIV/STDs. For example, police often take advantage of existing laws against prostitution to demand money or sex. In general, the strict enforcement of anti-prostitution laws marginalizes prostitutes from services which could help them avoid abuse and promotes an environment in which prostitutes must take risks to avoid detection and arrest. One strategy to improve prostitutes' lives would therefore be to remove laws which prevent them from working safely and from travelling abroad to work legally. Projects in which prostitutes are actively involved have helped break down stereotypes against prostitutes, while police-sex worker liaison projects in Scotland and Australia have led to higher levels of reporting of crimes against prostitutes. The Network of Sex Work Projects (NSWP), an organization which links sex worker health programs around the world, has found that the incidence of HIV/STDs among prostitutes is lowest when they have control over their work conditions; access to condoms, lubricants, and other safe sex materials; and respect of their basic human and legal rights. People need to understand that consensual involvement in sex work is different from forced sex trafficking.     

Impact of health education on prostitutes'' awareness and attitudes to acquired immune deficiency syndrome (AIDS)

767 female prostitutes in Maiduguri, Nigeria responded to a questionnaire on AIDS. Their motives and activities, awareness of HIV, transmission, prevention, and cure of AIDS and attitudes towards HIV carriers were examined. Researchers administered this questionnaire after the prostitutes had attended health education sessions on AIDS. Approximately 78% of the prostitutes were under 30 years old and 72.6% were married or had been married. 74.58% were mothers. 27% originated from neighboring countries. Patrons included civil servants, businessmen, petty traders, and craftsmen. On average, each prostitute entertained 3.3 customers/day and had sex with 1046 customers/year. 85.92% of the prostitutes claimed financial reasons such as supporting their children, for practicing prostitution. The majority of the women indicated that they generally received injections of antibiotics to prevent sexually transmitted diseases (STDs) via reused syringes and needles. 7.04% admitted to having had an STD in the past, but the researchers believe the percentage is too low. No prostitute claimed to use any hard drugs. Even though the prostitutes were receptive to health education, only 7.1% remembered that AIDS is caused by a virus and 84.3% just could not remember the causative agent. The majority (75.7%) did remember that sexual intercourse is a mode of transmission, but only 50% realized that infected blood and blood products were modes of transmission. The majority of the prostitutes indicated that they would use a condom when having sex. In addition, all stated that, if they later learn that they carry HIV, they would stop practicing prostitution. Most of the women wanted some form of restriction for HIV carriers, such as confinement or hospitalization until a cure is found. These results suggest that health education is needed and must reach the general population.     

Human immunodeficiency virus and migrant labor in South Africa

The authors investigate the impact of the migrant labor system on heterosexual relationships on South African mines and assess the implications for the future transmission of human immunodeficiency virus (HIV) infection. The migrant labor system has created a market for prostitution in mining towns and geographic networks of relationships within and between urban and rural communities. A section of the migrant workforce and a group of women dependent on prostitution for economic support appear especially vulnerable to contracting HIV infection since they are involved in multiple sexual encounters with different, changing partners, usually without condom protection. Furthermore, sexually transmitted disease morbidity is extensive in the general and mineworker populations. Historically, migration facilitated the transmission of sexually transmitted diseases and may act similarly for HIV. Problems of combating the HIV epidemic in South Africa are discussed.     

The role of training in STD prevention and control

The World Health Organization (WHO) estimates that 340 million new cases of curable sexually transmitted diseases (STDs) (excluding HIV and herpes simplex virus) occurred in 1995. The level of infection with STDs is especially troubling in developing countries, where they cause considerable morbidity. The consequences of infection with STDs can be personal, social, and economic. STD control programs are based upon the principles of primary and secondary prevention. Primary prevention strategies involve preventing the occurrence of new infections, while secondary prevention strategies aim to improve the management of STDs, and thereby to reduce their transmission and subsequent associated morbidity and mortality. Both primary and secondary prevention strategies require the dissemination of information from health workers to the at-risk population at a grassroots level, usually in primary health care centers. Health workers must therefore have a comprehensive and up-to-date knowledge of the many aspects of STDs, and be confident in their ability to communicate that information to others. A study in Tanzania determined that improvement in primary health care, including the provision of worker training, resulted in a 40% reduction in the incidence of HIV. The Wellcome Trust's new Topics in International Health series provides information on STDs on an interactive CD-ROM covering the epidemiology, diagnosis, clinical features, and treatment of the major STDs, except HIV, which is the subject of a separate CD-ROM. The CD-ROM was designed to be used in training programs for medical students and health care workers.     

Women prostitutes in the AIDS era

The prevalence and nature of female prostitution in the west is considered, as are the main types of motivation for engaging in sex work. The variable tendency to define western prostitutes as causal agents in the transmission and spread of HIV/AIDS is noted, and the medical/epidemiological evidence against doing so briefly summarised. The impact of the AIDS pandemic on prostitutes and their work is discussed, as are a number of legal, ideological and representational issues relating to prostitution which have been given new salience by the AIDS debate. It is contended that the legal process continues to discriminate unjustly against women prostitutes; that a ‘double standard’ of sexual morality persists; and that prostitute groups have articulated a clear response to law and ideology, hinging on the de-criminalisation of uncoerced adult prostitution. It is suggested that one likely consequence of decriminalisation would be improved access to health education and care facilities, as relevant for the general health status of women workers as for STDs, including AIDS.     

The economic value of reductions in gonorrhea and syphilis incidence in the United States, 1990-2003

BACKGROUND: Prevention efforts can reduce the considerable health and economic burdens imposed by sexually transmitted diseases (STDs). The objective of this study was to estimate the reduction in direct medical costs associated with reductions in gonorrhea and syphilis incidence in the United States from 1990 to 2003. METHODS: Using published estimates of the per-case costs of STDs, we estimated the annual costs from 1990 to 2003 of four main outcomes: primary and secondary (P&S) syphilis, congenital syphilis, gonorrhea, and HIV costs attributable to the facilitative effects of gonorrhea and syphilis on HIV transmission and acquisition. RESULTS: Reductions in syphilis and gonorrhea from 1990 to 2003 have saved an estimated 5.0 billion dollars (in 2003 U.S. dollars): 1.1 billion dollars in costs associated with P&S syphilis, congenital syphilis, and gonorrhea, and 3.9 billion dollars in HIV costs attributable to syphilis and gonorrhea. In additional analyses, the estimated reductions in disease burden were substantially lower (1) when calculated incrementally (rather than cumulatively) and (2) when long-term costs of STDs were excluded. CONCLUSIONS: These estimated reductions in the burden of gonorrhea and syphilis show the economic benefits of reducing the incidence of these STDs and preventing their resurgence.     

Survey: most adults don't notify sex partners of STDs

A telephone survey of 1,000 men and 500 women shows that while most people with sexually transmitted diseases (STDs) have a responsibility to inform their sexual partners, only about one-third of men and women with STDs revealed the existence of the STD to their partner before having sex. For American adults, there is a 1 in 4 chance of contracting an STD during their lifetime compared to a 1 in 250 chance of getting HIV. However, most men and women have not been tested for any STDs besides HIV. American adults seriously underestimate their risk of contracting STDs, and very few are aware of the different types of STDs that exist.     

Eradicating chancroid

Genital ulcers are important cofactors of HIV transmission in the countries most severely affected by HIV/AIDS. Chancroid is a common cause of genital ulcer in all 18 countries where adult HIV prevalence surpasses 8% and is rare in countries with low-level HIV epidemics. Haemophilus ducreyi, the causative organism of chancroid, is biologically vulnerable and occupies a precarious epidemiological niche. Both simple, topical hygiene and male circumcision greatly reduce risk of infection and several classes of antibiotics--some of which can be administered in single-dose treatment regimens--provide rapid cure. H. ducreyi depends on sexual networks with high rates of partner change for its survival, thriving in environments characterized by male mobility and intensive commercial sex activity. Elimination of H. ducreyi infection from vulnerable groups results in disappearance of chancroid from the larger community. Once endemic in Europe and North America, chancroid began a steady decline early in the twentieth century, well before the discovery of antibiotics. Social changes--resulting in changing patterns of commercial sex--probably disrupted the conditions needed to sustain chancroid as an endemic disease. Sporadic outbreaks are now easily controlled when effective curative and preventive services are made available to sex workers and their clients. More recently, chancroid prevalence has declined markedly in countries such as the Philippines. Senegal, and Thailand, a development that may contribute to stabilization of the HIV epidemics in these countries. Eradication of chancroid is a feasible public health objective. Protecting sex workers and their clients from exposure to sexually transmitted diseases (STDs) and improving curative services for STDs are among the proven strategies that could be employed.     

Associated with Differences in Sexual Risk-Taking Behaviors Among Migrants in South Korea

We investigated influential factors on differences in sexual risk-taking among homosexual migrants. The data used in this paper are based on the survey and medical examination for migrants’ sexual behaviors that was carried out by the Korea Federation for HIV/AIDS Prevention in 2011–2013 on participants living in South Korea. Among 1141 migrants, homosexuals were 0.54 times less likely to use condom than heterosexuals. Homosexuals were 2.93 times more likely to be infected with sexually transmitted diseases (STDs) than heterosexuals. Among 250 homosexual migrants, those who preferred risky sexual intercourse were 0.19 times less likely to use a condom than heterosexual migrants. Those who have a fixed sexual partner were 0.35 times less likely to be infected with HIV than their counterparts. Administrative programs for STDs prevention of migrants should be focused on their sexual risk-taking, which were limited to casual partnership, unprotected sex, and previous contraction of sexual diseases.     

Community-based trials of sexually transmitted disease treatment: repercussions for epidemiology and HIV prevention

This paper reviews the scientific basis for trials exploring the relation between sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) infection in Mwanza in the United Republic of Tanzania and Rakai and Masaka in the Republic of Uganda. The importance of a study's location and explanations for the divergent results of these trials are discussed. The modest effect on STDs seen in the trial of syndromic management in Mwanza, in contrast to the 38% reduction in the incidence of HIV, casts doubt on the underlying hypothesis that treating STDs alone slows the transmission of HIV-1. According to the Piot-Fransen model, the trial in Rakai, which offered treatment of STDs to all subjects irrespective of symptoms ("mass" treatment), should have been more effective both in reducing the prevalence of STDs and the incidence of HIV. However, the Rakai trial was stopped because there was no difference in the incidence of HIV between the intervention and control arms. If Mwanza is seen as the trial that needs explaining, another paradigm becomes relevant. In rural East Africa, where all trials have been conducted, networks of concurrent sexual partnerships are a source of infection with both STDs and HIV. Because of their shorter latency periods, STDs may prompt attendance at a clinic before the early signs of HIV-1 infection appear. Part of the management of STDs is to recommend abstinence or the consistent use of condoms until treatment is completed. This recommendation may cover the earliest period of viraemia during primary HIV-1 infection. This paradigm appears to explain the results from Mwanza and Rakai, emphasizing behavioural aspects of syndromic management.     

Rural perspectives on HIV/AIDS prevention: a comparative study of Thailand and Ghana

The paper compares rural perspectives in Thailand and Ghana on the level of condom acceptance in sexual relations, willingness to test oneself for HIV before and in marriage and sources of information on HIV/AIDS. We also compared the policy approaches to combating HIV/AIDS in both countries. The results indicates that in the villages studied in Thailand, all single men and the majority of the single women were in favour of using condoms in sexual relations. This group also showed a positive attitude to HIV/AIDS test before and in marriage. However, married men in rural Thailand disapproved of the use of condoms with their wives but married women in the sample population were open to the possibility of using condoms. Both married men and women were strongly against HIV/AIDS test in marriage. In contrast to Thailand, most single men in the communities studied in Ghana showed a disapproval to the use of condoms in sexual relations. However, they condoned HIV test before marriage. Married men and women in rural Ghana were against the use of condoms in sexual relations as well as HIV/AIDS test in marriage. In order to mitigate mother-to-child transmission, the Thais applied anti-retroviral drug care for HIV positive pregnant women during pregnancy and after delivery. In Ghana on the other hand, pregnant women were subject to HIV test and counselling. The mode of information acquisition on HIV/AIDS in both countries were through the media, campaigns and village volunteers. Finally, we observed that fighting poverty is a sine qua non for the success of any HIV/AIDS eradication programme.     

The anthropology of sexually transmitted disease in Liberia

In sub-Saharan African countries where AIDS is established, HIV transmission is primarily by means of heterosexual intercourse. A major co-factor in such transmission is the presence of other, sexually transmitted diseases (STDs). Efforts to limit the heterosexual transmission of HIV in Africa must therefore address the high prevalence of other, standard STDs. The present study attempts to establish a preliminary information base for interventions to prevent the spread of HIV in Liberia where there is relatively high incidence of standard STDs but low incidence of HIV seropositivity. Employing in-depth, key-informant interviews with traditional healers, prostitutes and others, as well as focus group discussions with groups selected on the basis of several criteria, knowledge, beliefs, attitudes and behavior related to AIDS and STDs were elicited. Although evidence of exposure to scientific concepts was found, traditional, ethnomedical views predominated. Notions of sorcery, taboo violation and contamination were often expressed when describing the etiologies of locally-recognized sexually transmitted diseases. More 'naturalistic' explanations were often based on simplified notions of human anatomy and biochemistry. Three basic messages about AIDS that were broadcast in a recent radio campaign were retained, namely 'AIDS kills;' 'there is no cure for it;' and 'it is transmitted through sex.' There was also evidence of Liberians beginning to view AIDS in frameworks of interpretation compatible with traditional ethnomedical beliefs, such as sorcery. Most traditional healers reported they knew little or nothing about AIDS, including those who had a lot to say about other STDs that are well-established in Liberia. Many cases of STDs seem to be handled by traditional healers. Treatment typically consists of decoctions from the leaves and roots of various medicinal plants, administered as teas--less often as enemas or vaginal implants--to be taken over a 2-4 day period. It is recommended that efforts to lower incidence of standard STDs be given priority comparable to promotion of condom use and 'safer sex' in efforts to slow the transmission of HIV in Liberia. Strategies for combating STDs will have to take into account popular beliefs and attitudes regarding STDs as well as the role and influence of traditional healers. Strategies of this sort are recommended.     

Mortality related to sexually transmitted diseases in US women, 1973 through 1992.

OBJECTIVES: This study estimated the trends in mortality related to sexually transmitted diseases (STDs) and their sequelae in US women from 1973 through 1992. METHODS: The total number of deaths was obtained from US national mortality data and from AIDS surveillance data, and current literature was reviewed to estimate proportions of diseases attributable to sexual transmission. RESULTS: From 1973 through 1984, total STD-related deaths decreased 24%. However, from 1985 through 1992, STD-related deaths increased by 31%, primarily because of increasing numbers of deaths from sexually transmitted human immunodeficiency virus (HIV) infection. The most important changes during the 20-year period were the emergence of and continued increase in the number of deaths related to hetero-sexually transmitted HIV. CONCLUSIONS: The leading causes of STD-related mortality in women, viral STDs and their sequelae, are generally not recognized as being sexually transmitted. Increases in STD-related mortality are primarily due to sexually transmitted HIV, which will soon surpass cervical cancer as the leading cause.     

Awareness and Knowledge of Sexually Transmitted Diseases Among Secondary School Students in Two German Cities

Several western countries have reported increases of sexually transmitted diseases such as gonorrhea, syphilis and chlamydia since the mid-1990s, especially among teenagers 16–19 years old. We conducted a school-based survey to assess awareness and knowledge of STDs among students attending the 8th grade and above in Bremen and Bremerhaven, two cities in northern Germany. Between October and December 2011 students completed an anonymous questionnaire on awareness and knowledge of STDs in 8 different schools. To assess awareness of STDs, the students were asked to indicate which STDs they had heard of. Knowledge of STDs was assessed based on 4 general questions. Furthermore, comprehensive awareness of HPV was assessed based on 3 items. We assessed differences in HPV awareness and knowledge of STDs by key demographic variables such as age, gender and migrant background. A total of 1,148 students aged 12–20 years (response 28 %) completed the questionnaire. 31 % had a migrant background and 55 % were girls. Almost all students had heard of HIV/AIDS, but only 23 % of chlamydia and 13 % of HPV. Significantly more girls than boys had heard of HPV (18 vs. 8 %) and chlamydia (31 vs. 16 %). Generally, low levels of STD knowledge and awareness of HPV were observed. In multivariable analyses, age, gender, and ever having had sex were associated with both STD knowledge and awareness of HPV. HIV/AIDS remains the only sexually transmitted disease most students have heard of. Sex education at school needs to be broadened to include STDs other than HIV/AIDS.     

HIV/STDs in minority women: educational and medical interventions to alter the spread

HIV is but one form of sexually transmitted disease (STD). Many of the other STDs, especially those that produce ulcerating lesions, such as herpes simplex, syphilis, and chancroid, are associated with increased shedding of HIV if the individual is seropositive, and with increased risk of infection if a seronegative individual with that type of STD has unprotected intercourse with an HIV-positive partner. Thus, control and treatment of other STDs is very important in the management and prevention of the spread of HIV/AIDS.     

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

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

Sexually transmitted diseases, unintended pregnancy, and adolescent health promotion

Adolescence is a critical period in the development of sexual behaviors that may lead to acquiring sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), and to unintended pregnancy. Understanding adolescent sexual behavior is essential for understanding adolescents' risk of pregnancy and STD/HIV infection and for planning and evaluating health promotion activities. This chapter reviews the sexual behaviors and psychosocial factors associated with STDs and unintended pregnancy among adolescents as well as school-, community-, and clinic-based interventions designed to reduce risk behaviors and promote adolescent sexual health.