Longitudinal patterns of sexual behavior and condom use in a cohort of HIV-negative gay and bisexual men in Vancouver, British Columbia, Canada, 1995-2000

OBJECTIVE: To characterize longitudinal patterns of sexual behavior in a cohort of young gay and bisexual men and determine their reasons for not using condoms. METHODS: Prospective data from a cohort of young gay and bisexual men aged 18 to 30 years were studied. Study participants had completed a baseline questionnaire and HIV test between May 1995 and April 1996 and four annual follow-up questionnaires. RESULTS: A total of 130 HIV-negative Vanguard participants met the eligibility criteria for this analysis. The median age at baseline was 26 years (range, 24-28). Most were white (79%), had completed high school (85%), were currently employed (82%), lived in stable housing (95%), and reported annual incomes of > or =$10,000 (82%). (All dollar amounts are given in Canadian dollars.) Consistently over the 5-year study period, > 70% of study subjects reported having > or =1 regular male sexual partners in the previous year. During each of the five successive 1-year periods, between 34% and 40% of respondents reported having had unprotected receptive anal intercourse with regular partners. Slightly fewer individuals (between 29%-39%) reported having had unprotected insertive anal intercourse with regular partners. Between 13% and 25% of participants reported having had insertive unprotected anal intercourse with casual sexual partners; and between 9% and 18% reported having had unprotected receptive anal intercourse with casual sexual partners. Reasons for engaging in unprotected anal intercourse varied depending on type of sexual partnership. CONCLUSION: High-risk sexual behaviors remained fairly consistent over a 5-year period in this study. This suggests that it is critically important to understand the motivations for unprotected sex when designing and implementing programs aimed at reducing HIV risk among young gay and bisexual men.     

Effects of a coping intervention on transmission risk behavior among people living with HIV/AIDS and a history of childhood sexual abuse

OBJECTIVES: To examine the effect of a 15-session coping group intervention compared with a 15-session therapeutic support group intervention among HIV-positive men and women with a history of childhood sexual abuse (CSA) on sexual transmission risk behavior. DESIGN: A randomized controlled behavioral intervention trial with 12-month follow-up. METHODS: A diverse sample of 247 HIV-positive men and women with histories of CSA was randomized to 1 of 2 time-matched group intervention conditions. Sexual behavior was assessed at baseline; immediately after the intervention; and at 4-, 8-, and 12-month follow-up periods (5 assessments). Changes in frequency of unprotected anal and vaginal intercourse by intervention condition were examined using generalized linear mixed models for all partners, and specifically for HIV-negative or serostatus unknown partners. RESULTS: Participants in the HIV and trauma coping intervention condition decreased their frequency of unprotected sexual intercourse more than participants in the support intervention condition for all partners (P < 0.001; d = 0.38, 0.32, and 0.38 at the 4-, 8-, and 12-month follow-up periods, respectively) and for HIV-negative and serostatus unknown partners (P < 0.001; d = 0.48, 0.39, and 0.04 at the 4-, 8-, and 12-month follow-up periods, respectively). CONCLUSION: A group intervention to address coping with HIV and CSA can be effective in reducing transmission risk behavior among HIV-positive men and women with histories of sexual trauma.     

Developmental plasticity of human reproductive development: effects of early family environment in modern-day France

In a first study, we investigated how the absence of a father and the presence of a stepfather during early childhood affected physiological and behavioral traits related to reproductive development (such as age of menarche, age of first sexual intercourse and number of sexual partners) in a large sample set of male and female French university students. We evaluated which ages were sensitive to modifications in the family composition and found that menarche occurred earlier when the father was absent, particularly when the child was between 0 and 5 years of age. Father absence during early adolescence was associated with a younger age at first sexual intercourse and an increased number of sexual partners, for both sexes. The presence of a stepfather during this period further advanced the age of first sexual intercourse. We also measured testosterone levels in both sexes and analyzed their association with parental separation, and found that young women with separated parents had significantly higher afternoon levels of testosterone. In a second study, we analyzed direct fitness measures (such as number of children and grandchildren) in a large sample of French workers and found that parental separation during childhood was not associated with fitness variation. We discuss whether the reproductive outcomes of individuals having experienced modifications in the early family environment are the expression of costs or adaptive strategies.     

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.     

A longitudinal study of the effects of menopause on sexuality

From an initial group of 39, 16 cycling peri-menopausal women completed a longitudinal study in which they recorded menstrual and sexual behavior daily and were interviewed at roughly 4-mth intervals until 1 yr or more without cycling. At each interview women gave 20-ml blood samples, completed sexuality questionnaires, and rated themselves for menopausal symptoms. As predicted, the difference in weekly rate of sexual intercourse before and after the cycle showed a significant decline (P less than 0.05). For each subject, mean weekly rates of sexual intercourse for 13-wk periods over the entire transition period were plotted and the slope of the line was calculated. Overall, the mean slope was negative, as predicted, and was significantly different from zero (P less than 0.05). The questionnaire data showed that compared with their pre-menopause data, the women had fewer sexual thoughts or fantasies (P less than 0.01), suffered more from lack of vaginal lubrication during sex (P less than 0.01), and were less satisfied with their partners as lovers (P less than 0.05) after menopause. While estradiol (E) and testosterone (T) levels showed significant declines (P less than 0.02), testosterone showed the most consistent association with coital frequency. The findings generally supported our initial hypothesis of a decline in sexual interest and coital frequency after menopause.     

The Influence of Social Support, Coping and Mood on Sexual Risk Behavior among HIV-Positive Men and Women

The purpose of this study was to examine the relationships between social support, coping, mood and sexual risk behavior. Participants were 122 HIV-positive adults (60 women and 62 men). All participants were assessed on sexual risk behavior, perceived partner social support, coping with HIV/AIDS and mood. The results showed that sexual risk behavior was associated with male gender, education, perceived support of their partners and the use of emotion-focused coping style to deal with living with HIV and AIDS. Intervening with partners and developing effective coping strategies may decrease risk among HIV-positive men and women. Indeed, effective HIV prevention interventions must consider the social, psychological and cultural context in which sexual risk behavior occurs and develop strategies that intervene on these psychosocial factors.     

Sexual and reproductive life of women informed of their HIV seropositivity: a prospective cohort study in Burkina Faso.

BACKGROUND: In the context of the DITRAME-ANRS 049 research program that evaluated interventions aimed at reducing mother-to-child transmission of HIV (MTCT) in Bobo-Dioulasso (Burkina Faso), Voluntary HIV counseling and testing (VCT) services were established for pregnant women. HIV-infected women were advised to disclose their HIV serostatus to their male partners who were also offered VCT, to use condoms to reduce sexual transmission, and to choose an effective contraception method to avoid unwanted pregnancies. This study aimed at assessing how HIV test results were shared with male sexual partners, the level of use of modern contraceptive methods, and the pregnancy incidence among these women informed of the risks surrounding sexual and reproductive health during HIV infection. METHODS: From 1995 to 1999, a quarterly prospective follow-up of a cohort of HIV-positive women. RESULTS: Overall, 306 HIV-positive women were monitored over an average period of 13.5 months following childbirth, accounting for a total of 389 person-years. The mean age at enrollment in the cohort was 25.1 (standard deviation, 5.2 years). In all, 18% of women informed their partners, 8% used condoms at each instance of sexual intercourse to avoid HIV transmission, and 39% started using hormonal contraception. A total of 48 pregnancies occurred after HIV infection was diagnosed, an incidence of 12.3 pregnancies per 100 person-years. Pregnancy incidence was 4 per 100 person-years in the first year of monitoring and this rose significantly to 18 per 100 person-years in the third year. The only predictor of the occurrence of a pregnancy after HIV diagnosis was the poor outcome of the previous pregnancy (stillbirth, infant death). Severe immunodeficiency and change in marital status were the only factors that prevented the occurrence of a pregnancy after HIV diagnosis. CONCLUSION: Our study shows a poor rate of HIV test sharing and a poor use of contraceptive methods despite regular advice and counseling. Pregnancy incidence remained comparable with the pregnancy rate in the general population. To improve this situation, approaches for involving husbands or partners in VCT and prevention of MTCT interventions should be developed, evaluated, and implemented.     

Occurrence of down syndrome and human sexual behavior

We analyzed the sexual habits of 80 mothers of normal children and of 33 mothers of children with the Down syndrome (DS). The data were obtained through the psychological interview technique. Unusually long intervals between intercourse at the time of conception were reported more frequently by mothers of DS children. Independent of the mother's age there was an association between the incidence of DS and long intervals between intercourse.     

Sexual behavior of college women in 1975, 1986, and 1989

To compare sexual practices in college women before and after the start of the current epidemics of Chlamydia trachomatis, genital herpesvirus, and human immunodeficiency virus type 1 infection, we surveyed 486 college women who consulted gynecologists at a student health service in 1975, 161 in 1986, and 132 in 1989 at the same university. There were no statistically significant differences in age, age at menarche, or reason for visiting the gynecologist. The percentages of women in this population who were sexually experienced were the same in all three years (88 percent in 1975, 87 percent in 1986, and 87 percent in 1989). Oral contraceptives were used by 55 percent of the women in 1975, 34 percent in 1986, and 42 percent in 1989; the use of condoms as the usual method of birth control increased (6 percent in 1975, 14 percent in 1986, and 25 percent in 1989; P less than 0.001). In 1975, only 12 percent reported the regular use of condoms during sexual intercourse, in some cases in conjunction with other methods of contraception, as compared with 21 percent in 1986 and 41 percent in 1989 (P = 0.0014). No significant differences were found in the three surveys in the number of male sexual partners or the frequency of fellatio, cunnilingus, or anal intercourse. An additional sample of 189 college women who did not consult the health service was surveyed in 1989, and similar sexual behavior was reported by those who were sexually experienced (65 percent). We conclude that in this population there has been little change in sexual practices in response to new and serious epidemics of sexually transmitted diseases, with the exception of an increase in the use of condoms (which still does not reach 50 percent).     

A cluster of HIV infection among heterosexual people without apparent risk factors

Human immunodeficiency syndrome (HIV) epidemiology in Belgium shows that 66% of all acquired immunodeficiency syndrome patients were infected heterosexually. Since 1985, all HIV-seropositive patients in Brussels and Antwerp who have been heterosexually infected have been offered participation in a partner notification program; this article reports the case study of 1 HIV infected male and his 19 identified previous women sexual partners. This report describes the patient's background and the type and frequency of sexual intercourse he had with each partner. The characteristics of each of the sexual partners were also described. An important consideration of this case was that 11 of the tested partners (56%) were HIV seropositive. Several factors were discussed concerning the cause of this high rate of transmission (e.g. high disseminator patient, highly virulent HIV strain, and presence of genital herpes). This study emphasizes the fact that middle class women with low risk sexual practices were infected with AIDS from as little as 1 sexual encounter with this infected individual. To stop a false sense of security among people with few sexual partners, it was advised that a program of partner notification targeted to heterosexuals be implemented along with other public health policies.     

Age differences in sexual partners and risk of HIV-1 infection in rural Uganda

OBJECTIVES: To assess whether differences in age between sexual partners affect the risk of HIV infection in female adolescents and young adults. METHODS: A total of 6177 ever sexually active women aged 15 to 29 years completed a sociodemographic and sexual behavior questionnaire and provided a blood sample for HIV-1 serology. The age difference between partners was categorized as men 0 to 4 years older (referent group), 5 to 9 years older and 10 or more years older. HIV prevalence and incidence were assessed, and adjusted RR was estimated by multivariate regression. RESULTS: Prevalent HIV-1 infection in female participants increased with older male sexual partners. Among women aged 15 to 19 years, the adjusted risk of HIV infection doubled (RR = 2.04; 95% CI: 1.29-3.22) among those reporting male partners 10 or more years older compared with those with male partners 0 to 4 years older; among women 20 to 24 years of age, the RR was 1.24 (95% CI: 0.96-1.60). The attributable fraction (exposed) of prevalent HIV infection in women aged 15 to 24 years associated with partners 10 or more years older was 9.7% (95% CI: 5.2-14.0). HIV incidence did not increase with differences in age of partners. CONCLUSION: The age difference between young women and their male partners is a significant HIV risk factor, suggesting that high HIV prevalence in younger women is caused, in part, by transmission from older male partners.     

'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.     

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.     

Sexual behavior and HPV infection in British women, by postal questionnaires and telephone interviews

Sexually transmitted human papillomaviruses (HPVs), most frequently HPV 16, are the primary cause of cervical carcinogenesis. The aim of this study was to evaluate the relationship between sexual behavior and prevalence and acquisition of HPV infection among British women attending regular cervical screening who responded to postal questionnaires and/or telephone interviews. A total of 1,880 women who had been tested for HPV in the ARTISTIC (A Randomized Trial In Screening To Improve Cytology) trial were randomized to three methods of data collection: group 1 (questionnaire including sexual history, no interview), group 2 (questionnaire excluding sexual history, short interview including sexual history), and group 3 (questionnaire and long interview including sexual history in both). Questions on sexual history included age at first sexual intercourse, sexually transmitted diseases, lifetime (total and regular) sexual partners, and number of partners in the last 5 years (total and new). Demographics, reproductive, cervical screening, and smoking history were also collected in questionnaires. The overall participation rate was 35%. There was good agreement (87.4-95.5%) on sexual behavior answers in questionnaires and interviews in women in group 3 and no significant differences between data obtained by questionnaire or interview. Odds ratios (OR) for both HPV prevalence and acquisition increased consistently with increasing numbers of lifetime sexual partners, regular partners, and new partners in the last 5 years (recent partners). No significant association was found for other characteristics investigated. The effect of recent sexual partners on HPV acquisition (OR for 2+ recent partners: 4.4, 95% CI: 1.7-11.2) was stronger than that of earlier (> 5 years ago) partners (OR for 2+ earlier partners: 2.2, 95% CI: 0.7-6.7) suggesting that most incident HPV infections are newly acquired rather than recurrent.     

HIV transmission risk behavior among men and women living with HIV in 4 cities in the United States

Determining rates of HIV transmission risk behavior among HIV-positive individuals is a public health priority, especially as infected persons live longer because of improved medical treatments. Few studies have assessed the potential for transmission to the partners of HIV-positive persons who engage in high-risk activities. A total of 3723 HIV-infected persons (1918 men who have sex with men [MSM], 978 women, and 827 heterosexual men) were interviewed in clinics and community-based agencies in Los Angeles, Milwaukee, New York City, and San Francisco from June 2000 to January 2002 regarding sexual and drug use behaviors that confer risk for transmitting HIV. Less than one quarter of women and heterosexual men had 2 or more sexual partners, whereas 59% of MSM reported having multiple partners. Most unprotected vaginal and anal sexual activity took place in the context of relationships with other HIV-positive individuals. Approximately 19% of women, 15.6% of MSM, and 13.1% of heterosexual men engaged in unprotected vaginal or anal intercourse with partners who were HIV-negative or whose serostatus was unknown. The majority of sexually active participants disclosed their serostatus to all partners with whom they engaged in unprotected intercourse. An estimated 30.4 new infections (79.7% as a result of sexual interactions with MSM) would be expected among the sex partners of study participants during the 3-month reporting period. Eighteen percent of 304 participants who injected drugs in the past 3 months reported lending their used injection equipment to others. In addition to the more traditional approaches of HIV test counseling and of focusing on persons not infected, intensive prevention programs for persons with HIV infection are needed to stem the future spread of the virus.     

No increase in cervicovaginal proinflammatory cytokines after Carraguard use in a placebo-controlled randomized clinical trial

BACKGROUND: Assessment of cervicovaginal cytokine levels may be helpful to evaluate subclinical epithelial inflammation during safety evaluations of candidate microbicides. METHODS: Fifty-five HIV-seronegative Thai women were enrolled in a safety trial of the candidate microbicide Carraguard and were randomized to use Carraguard or placebo gel before vaginal sex. Cervicovaginal lavages were collected at baseline and after 1 month of gel use; levels of interleukin (IL)-1beta, IL-6, IL-8, and secretory leukocyte protease inhibitor (SLPI) were measured using microwell plate-based enzyme immunoassays. Median levels were compared between the baseline and 1-month follow-up visits using paired t tests; the median change between groups was compared using Wilcoxon rank sum tests. Women were examined for the presence of genital findings; the association between genital findings and cytokine levels was studied. RESULTS: No increase in levels of proinflammatory cytokines after use of Carraguard gel or placebo gel was observed during the study. The median change from the baseline to 1 month of follow-up was not significantly different between Carraguard and placebo groups (IL-1beta: -0.3 pg/mL vs. -3.93 pg/mL; P = 0.4, IL-6: -0.3 pg/mL vs. 0 pg/mL; P = 0.3, IL-8: -40.1 pg/mL vs. -53.2 pg/mL; P = 0.8, and SLPI: -26.5 pg/mL vs. 12.6 pg/mL; P = 0.07). Genital findings with intact epithelium were found in 16 (29%) women; these women tended to have somewhat higher IL-6 levels than those with normal epithelium (14.9 pg/mL vs. 8.8 pg/mL; P = 0.08). CONCLUSION: We found no increase in proinflammatory cytokines after Carraguard and placebo gel use, suggesting that neither gel causes inflammation. Further studies to assess the role of cytokines in microbicide safety studies are warranted.     

High prevalence of papillomavirus-associated penile intraepithelial neoplasia in sexual partners of women with cervical intraepithelial neoplasia

To determine whether neoplastic cervical lesions in women are associated with papillomavirus infections in their sexual partners, we used a colposcope to examine male sexual partners of women with cervical flat condyloma (294 cases) or cervical intraepithelial neoplasia (186 cases), before and after 5 percent acetic acid was applied to the penis and the anogenital area. Condylomata acuminata, papules, and macules were observed in 309 of the 480 men (64.4 percent). In 204 of them (42.5 percent), macules or slightly elevated papules were detected only after application of acetic acid. Condylomata acuminata or lesions showing histologic features of condyloma were found in 121 partners (41.2 percent) of women with condyloma, but in only 10 partners (5.4 percent) of women with cervical intraepithelial neoplasia. Penile lesions showing histologic features of intraepithelial neoplasia were found in 61 partners (32.8 percent) of women with cervical intraepithelial neoplasia, but in only 4 partners (1.4 percent) of women with flat condyloma. Thirty-six (60 percent) of the 60 macules or papules tested contained papillomavirus DNA sequences. Human papillomavirus types 16 and 33 were almost exclusively found in penile intraepithelial neoplasia. Type 6, type 11, and the recently recognized type 42 were found in lesions showing features of condyloma or minimal histologic changes. As yet uncharacterized papillomaviruses were found in 15 percent of the specimens. These data support the concept that cervical carcinomas and precancerous lesions in women may be associated with genital papillomavirus infection in their male sexual partners.     

Efficacy of a Carrageenan gel Against Transmission of Cervical HPV (CATCH): interim analysis of a randomized,double-blind,placebo-controlled,phase 2B trial

Objectives

To evaluate the efficacy of a carrageenan-based lubricant gel in reducing the risk of genital human papillomavirus (HPV) infections in women.