Childhood behavior problems linked to sexual risk taking in young adulthood: a birth cohort study

OBJECTIVE: To study whether behavioral and emotional problems during childhood predicted early sexual debut, risky sex at age 21 years, and sexually transmitted infections up to age 21 years. Some possible mediational pathways were also explored. METHOD: Participants were enrolled in the Dunedin Multidisciplinary Health and Development Study (n = 1,037), a prospective, longitudinal study of a New Zealand birth cohort born in 1972-1973. Data obtained at ages 5, 7, 9, 11, 13, 15, and 21 years were used. Adjustment was made for gender, socioeconomic status, parenting factors, and residence changes. RESULTS: High levels of antisocial behavior between age 5 and 11 years were associated with increased odds of early sexual debut (adjusted odds ratio [AOR] 2.17, 95% confidence [CI] 1.34-3.54) and risky sex (AOR 1.88, 95% CI 1.04-3.40). No relationship was observed between hyperactivity and later sexual health outcomes. In contrast, high levels of anxiety were associated with reduced odds of risky sex (AOR 0.45, 95% CI 0.25-0.80) and sexually transmitted infections (AOR 0.34, 95% CI 0.17-0.70). Involvement with delinquent peers explained some of the association between antisocial behavior and early sexual debut and risky sex. A poor relationship with parents also explained some of the association between antisocial behavior and early sexual debut. CONCLUSIONS: The findings demonstrate links between behavioral and emotional problems occurring early in life and later deleterious sexual health outcomes. Targeting antisocial behavior and teaching accurate appraisals of danger during childhood may help mitigate these negative consequences.     

Seroprevalence of herpes simplex virus type 2 in multiple sclerosis

BACKGROUND: It has been proposed that multiple sclerosis (MS) might be a sexually transmitted disorder. There is evidence that seropositivity to herpes simplex virus type 2 (HSV-2) correlates well with the number of sexual partners. Accordingly, a raised overall HSV-2 seroprevalence in MS would lend support to this theory. MATERIALS AND METHODS: Serum from 497 UK subjects with clinically definite MS was tested for antibodies to HSV-2 and compared with matched historical controls from within and outside London, blood donors and genito-urinary medicine (GUM) clinics. RESULTS: The unadjusted MS seropositivity rate was 14%. HSV-2 seroprevalence in MS patients aged 35-64 years was significantly higher overall compared with a non-London general population in an unadjusted comparison. HSV-2 seroprevalence in London MS patients compared with London blood donors was significantly greater irrespective of age, but the MS seropositive rate was lower than GUM clinic attenders. In a logistic regression analysis, increased age, female sex and MS diagnosis all independently increased the odds of seropositivity after adjustment for each other. CONCLUSION: It is concluded that there is increased likelihood of HSV-2 exposure in patients with MS and this may indicate a higher than average number of partners.     

The prevalence and correlates of sexual risk behaviors and sexually transmitted infections in outpatients with borderline personality disorder

This study examined the prevalence and correlates of sexual risk behaviors and sexually transmitted infections (STIs) in two samples of outpatients with borderline personality disorder (BPD), including suicidal BPD women (n = 99) and opiate-dependent BPD men and women (n = 125). High rates of sexual risk behaviors and STIs were found, particularly in the opiate-dependent BPD sample. Compared with suicidal BPD outpatients, opiate-dependent BPD outpatients reported higher rates of past-year sexual activity, commercial sex work, and lifetime hepatitis, as well as a greater number of lifetime sex partners. Substance use and demographic characteristics (age, sex, and marital status) were associated with higher rates of sexual risk behaviors and/or STIs, whereas cognitive-behavioral factors and indicators of psychiatric impairment were not. These findings point to a clear need for interventions aimed at decreasing sexual risk behaviors among individuals with BPD.     

Is multiple sclerosis a sexually transmitted infection?

It is proposed that multiple sclerosis may be transmitted chiefly by sexual contact. Arguments favouring this include: migration studies that suggest a transmissible agent in adolescence; clusters of multiple sclerosis which have occurred in low prevalence areas following entry of young males; the similarity of multiple sclerosis to tropical spastic paraplegia, a known sexually transmitted infection with resemblance to primary progressive multiple sclerosis; an increased rate in drug misusers; a similar age of onset and sex pattern to that found in sexually transmitted disease; increased incidence of multiple sclerosis in those using oral contraceptives; low multiple sclerosis rates in societies with a strict moral code; longitudinal shifts in sex prevalence that show an increase in women after the sexual revolution of the 1960s; and important exceptions to the worldwide distribution corresponding to countries with permissive attitudes to sex. Family, conjugal pair, twin, and adoption studies are compatible with an infectious cause of multiple sclerosis if this is sexually transmitted. It is not proposed that sexual transmission is the only cause but that inherited factors create a susceptibility to a sexually transmitted neurotropic agent. It is hoped this hypothesis might encourage a new direction of neurological research.     

Sexually transmitted disease rates and high-risk sexual behaviors in borderline personality disorder versus borderline personality disorder with substance use disorder

We examined the rates of sexually transmitted diseases (STDs) in women with borderline personality disorder (BPD) (using PDE and SCID-II) and substance abuse or dependence (SCID-I) (BPD-SUD) (N=82) compared with those with BPD-only (N=102), exploring mediators of this relationship. Participants were interviewed about STD history (gonorrhea, genital herpes, syphilis, trichomonas, human papillomavirus, and HIV), condom use, number of sexual partners, poverty, and prostitution. BPD-SUD appeared to be particularly at high risk for STDs, reporting significantly more STDs than BPD (F[1,172]=11.74, p=0.001, d=.27), particularly for gonorrhea, trichomonas, and human papillomavirus. The relationship between BPD-SUD and STDs is mediated by poverty, prostitution in the last year, recent unprotected sex with two or more partners, and >20 lifetime partners (z=-2.16 which is p=0.03), with prostitution alone making a significant contribution to this relationship (z=-2.49, p=0.01).     

Onset of epilepsy and menarche—Is there any relationship?

PURPOSE: Women with epilepsy have increased frequency of reproductive health problems compared to women without epilepsy. In puberty, reproductive hormonal changes during sexual maturation may affect epilepsy and induce the debut of seizures as indicated in some studies. On the other hand, epileptic activity affects sex hormone function, which may induce alterations in pubertal endocrine maturation and thereby menarche age. We wanted to investigate the relation between epilepsy and menarche age in a larger population of female epilepsy patients. METHODS: A retrospective, questionnaire study of a cohort of 265 female outpatients from three Norwegian hospitals and 142 controls, aged 18-45 years was conducted. Parameters regarding epilepsy and reproductive health issues were registered. Perimenarche was defined as 2 years before and 2 years after the year of menarche. RESULTS: There was a significantly higher frequency of patients with epilepsy debut between 10 and 18 year compared to 0-9 years (p<0.01). There was, however, no significant difference in occurrence of epilepsy debut in the perimenarche period compared to the 5 year periods before and after perimenarche, and no significant difference in epilepsy debut in the year of menarche compared to the 5 years before or after. Menarche age was not significantly different in those with epilepsy debut before or after menarche. Epilepsy type (idiopathic generalised or partial) did not influence the menarche age. CONCLUSIONS: The study did not confirm the former observations of clustering of epilepsy debut at menarche or in the perimenarche period or alterations in menarche age in girls with epilepsy. However, onset of epilepsy is more frequent in the adolescent years (10-18), than in childhood (0-9).     

AIDS/HIV risk behavior among the chronic mentally ill.

OBJECTIVE: There is growing concern that chronic mentally ill adults living in the community have a high risk for HIV infection. The purpose of this study was to identify risk knowledge, high-risk behaviors, and risk-related encounters of chronic psychiatric outpatients. METHOD: Detailed information on high-risk behaviors and risk-related situations during the past 12 months was collected from 60 outpatients appearing for regular visits at inner-city community mental health clinics. RESULTS: Of the 60 outpatients, 37 (62%) had been sexually active during the past year, and 42% of the men and 19% of the women reported multiple sexual contacts and infrequent use of condoms during intercourse. Assessments of the patients' knowledge of AIDS risks revealed substantial deficits in their practical understanding of AIDS and risk reduction measures. Although use of intravenous drugs was uncommon in this group, many subjects reported histories of 1) trading sex for money, drugs, or a place to stay, 2) coercion to engage in unwanted sex, 3) causal sexual encounters, and 4) sexual activity after use of drugs or intoxicants. Twenty percent of the subjects had met their sexual partners on the streets, in parks, or in other public places. One-third had been treated for sexually transmitted diseases other than AIDS. CONCLUSIONS: These findings underscore the need for AIDS risk assessment, counseling, and prevention programs for the chronic mentally ill.     

Severely Mentally Ill Women’s HIV Risk: The Influence of Social Support,Substance Use,and Contextual Risk Factors

In structured interviews with 96 women with severe mental illness, nearly two-thirds had not used condoms during sexual intercourse in the past 3 months, more than two-thirds had sex with multiple partners, and almost one-third had been treated for a sexually transmitted infection (STI) in the past year. Women who reported fewer sexual risk context factors, such as having sex with someone the participant did not know or transactional sex, had fewer sexual partners. Larger social support networks were associated with less frequent sex after drug use. In turn, women who less often had sex after using drugs had unprotected intercourse less frequently. Mary E. Randolph, Steven D. Pinkerton, Anton M. Somlai, Jeffrey A. Kelly, Timothy L. McAuliffe, and Kristin Hackl are affiliated with Center for AIDS Intervention Research, Department of Psychiatry & Behavioural Medicine, Medical College of Wisconsin, Milwaukee, WI 53202, USA. Richard H. Gibson is affiliated with Zablocki Veterans Affairs Medical Center, Milwaukee, WI USA.     

Tracing the roots of early sexual debut among adolescents in psychiatric care

OBJECTIVE: To identify the most important social and personal characteristics related to early sexual debut among troubled teenagers. METHOD: One hundred ninety-eight youths aged 12-19 years were recruited from outpatient mental health clinics and completed self-reports and interviews about their age of sexual debut; family, peer, and partner relationships (e.g., parental hostile control, negative peer influence, need for intimacy); and personal characteristics (e.g., achievement motivation, externalizing problems). Broad-band (externalizing, internalizing) and narrow-band (depression/anxiety, delinquency) psychopathology was assessed with the Youth Self-Report and Child Behavior Checklist. RESULTS: Optimal Data Analysis was used to generate a classification tree model to identify variables associated with whether or not youths initiated oral, vaginal, and/or anal sexual activity before or after age 14. Three social context variables (parental hostile control, negative and positive peer influence) and one personal characteristic (externalizing problems) correctly classified 87.4% of teenagers as initiating sexual activity at < or =14 or >14 years of age. CONCLUSIONS: Parental behavior and peer influence were the most important variables associated with the timing of sexual debut. Results support a social-personal framework for understanding sexual risk-taking among adolescents in psychiatric care, and the data offer relatively strong evidence that specific factors could be used to identify troubled teens at risk for early sexual debut.     

The effects of dating violence, substance use and risky sexual behavior among a diverse sample of Illinois youth

This study examines the relationship between dating violence, forced sexual intercourse (FSI), and four measures of sexual risk taking (i.e., age at first sex, number of recent (within the last three months) sex partners, alcohol/drug use at last sex, and condom use at last sex) among a sample of 1124 ethnically diverse sexually active adolescents in Illinois. Given conflicting reports regarding the role of gender in dating violence, and the dearth of research examining the role of gender in relations between dating violence, sexual violence, and sexual risk taking, we also examine whether gender moderates the relation between these constructs. The findings indicate significant relationships among dating violence and FSI and age at first sex, number of sexual partners, and condom use across various ethnic groups. Findings also show that when controlling for gender, dating violence and FSI are related to number of sexual partners and age at first intercourse regardless of ethnic group identification.     

Adolescents and sexual risk-taking: The interplay of constraining relationship beliefs,healthy sex attitudes,and romantic attachment insecurity

IntroductionAlthough sexual exploration during adolescence may be perceived as normative, many adolescents who are sexually active are likely to engage in risky sexual behaviors detrimental to their well-being. The present study examined the influence of insecure attachment (anxious and avoidant dimensions), healthy sex attitudes, and constraining relationship beliefs on the following sexual risk indicators: age at first sex, number of sexual partners, condom use, length of time knowing sexual partners, seriousness of relationship, and frequency of sex.MethodsCross-sectional data from two cohorts recruited one year apart for a five-year project were analyzed. Adolescents were public high school students from a Southern state in the USA (cohort 1: N = 878, 51.1% females, M = 16.50 years old; cohort 2: N = 759, 46.9% females, M = 15.78 years old).ResultsAcross both cohorts, healthy sex attitudes were related to having sex for the first time at an older age, having less sexual partners in a lifetime, and knowing one's sexual partner longer. High scores on the avoidant attachment dimension were related to less commitment to the relationship. This dimension also was related to holding lower scores on healthy sex attitudes, which in turn was related to having more sexual partners and knowing one's sexual partner for a shorter time. Although not replicated, higher endorsement of constraining relationship beliefs was associated with inconsistent condom use and greater sex frequency.ConclusionFindings suggests that attachment insecurity, healthy sex attitudes, and constraining relationship beliefs work together to influence adolescent sexual risks.     

Risk behaviors for sexually transmitted infections among men with mental disorders

OBJECTIVE: Risk behaviors for sexually transmitted infections among men with mental disorders who were using outpatient psychiatric services and among men who had never been treated for a mental disorder were compared. METHODS: Ninety-two men with major mental disorders, including schizophrenia, bipolar disorder, and mood disorders, were individually matched for age and ethnicity with 92 men who had never been treated for mental illness. All subjects completed a semistructured interview about specific risk behaviors for sexually transmitted infections that they may have engaged in during the preceding year. RESULTS: The 49 patients with mental disorders who had been sexually active in the preceding year were significantly more likely than the 78 sexually active comparison subjects to have known their sexual partner for less than one day and to report having been pressured into unwanted sexual intercourse. A strong but not significant trend was found for sexually active patients to have had sex with a male partner and sex with a drug user. Overall, the patients with mental disorders answered ten questions measuring AIDS knowledge questions significantly less well than the comparison subjects. CONCLUSIONS: The results underscore the priority for developing programs for preventing risk behaviors for sexually transmitted infections among men with mental disorders.     

Sexual function and ways of coping in patients with multiple sclerosis and their partners

The sexual and marital life of people with multiple sclerosis (MS) and their partners is frequently affected by the disease. One hundred and sixteen MS sufferers (72 females, 44 males) and their partners were questioned about their sexual and marital satisfaction; specific sexual difficulties caused by MS; and ways of coping with sexual problems. Demographic data, impact and acceptance of MS, cognitive functioning and mood state were also measured. Results showed that both male and female patients had sex lives that were greatly affected by their disability. Problems included indirect physical changes (numbness, spasms and fatigue); direct sexual dysfunctions (impotence, vaginismus and anorgasmia); concerns about future changes (incontinence, fertility); and sexuality-related changes (priorities, expectations and communication with partner). Men had higher levels of sexual dysfunction and talked to their doctors more frequently compared with women. Three percent of women and 25% of men had been to a sexual therapist. Spouses also indicated high levels of sexual dysfunction, including the area of non-sensuality. Relationship difficulties were present in a third of the sample, with female partners being the most dissatisfied. Sexual dysfunction in patients was not associated with age, duration of illness or mood state. Partners' sexual dysfunction was associated with patients' age, duration of MS and illness impact.     

Psychosocial and behavioral correlates of seeking sex partners on the internet among hiv-positive men

Background: The Internet is revolutionizing how people access and use information; for some people, the Internet is also redefining interpersonal relationships, including sexual relationships.Purpose: The objective of this study was to extend the understanding of HIV-positive men who use the Internet to meet sex partners.Methods: This study examined the use of the Internet for meeting sex partners among 141 sexually active HIV-positive men who completed anonymous surveys.Results: Results showed that 37% of sexually active HIV-positive men who were using the Internet had gone online to seek potential sex partners in the previous 3 months. Seeking sex partners online was associated with greater likelihood of having HIV-negative sex partners and engaging in unprotected intercourse with HIV-negative or unknown HIV status partners. Multivariate analyses showed that seeking sex partners online was associated with greater education, higher CD4 cell counts, using the Internet for sexual entertainment, and higher Sexual Compulsivity scale scores over and above demographic, health, Internet use, sexual behavior, and other psychosocial characteristics including optimism and depression.Conclusions: Results suggest a continued need for interventions targeting HIV transmission risk reduction among HIV-positive men who use the Internet to meet potential sex partners. We thank the AIDS Survival Project of Atlanta for their assistance with data collection. National Institute of Mental Health (NIMH) Grant We thank the AIDS Survival Project of Atlanta for their assistance with data collection. National Institute of Mental Health (NIMH) Grant     

Sexual health seeking behaviours of young people in the Gambia

In the Gambia, sexually transmitted infections (STIs) and their complications are a major health problem and although the prevalence of HIV-1 in the Gambia is currently low, it is increasing. Relatively little is known about the sexual health treatment-seeking behaviours of young people in West Africa. This information is vital to target resources appropriately. To investigate this concept, twelve single-sex focus group discussions (FGDs), within three rural villages, elicited the views, opinions, attitudes and experiences of 49 young men (mean age 17.4 years; range 15-21) and 48 young women (mean age 18.2 years; range 15-25). The participants talked openly about sexual activity within their peer communities. Six major themes were identified from the FGDs: (1) groups perceived to be at risk of acquiring STIs; (2) STI transmission and classification; (3) treatment-seeking behaviours; (4) barriers to treatment; (5) consequences of non-treatment; and (6) problem resolution strategies. The study concludes that whilst there may be barriers to improving sexual and reproductive health, young people in rural West Africa have enthusiasm for and commitment to finding solutions to the problems that local communities face.     

HIV risk behaviors and their relationship to posttraumatic stress disorder among women prisoners

OBJECTIVE: This study assessed HIV risk behaviors and their association with psychiatric disorders among women prisoners. METHODS: HIV risk behaviors practiced in the five years before incarceration were ascertained with the Risk Behavior Assessment interview for 177 inmates at the Maryland Correctional Institution for Women. The Structured Clinical Interview for the DSM-IV was used to determine the occurrence of posttraumatic stress disorder (PTSD), major depression, and dysthymic disorder among the women. Regression models were used to determine the association between HIV risk behavior and psychiatric disorders. RESULTS: HIV risk behaviors in the five years before incarceration included never or rarely having used condoms (56 percent of the women), injection drug use (42 percent), sexual intercourse with a partner who used injection drugs (42 percent), prostitution (30 percent), needle sharing (30 percent), receptive anal sex (19 percent), and having more than 100 sex partners (7 percent). After the analysis adjusted for age, education, race, HIV status, and addictive disorders, a lifetime occurrence of PTSD was associated with the practice of anal sex (odds ratio=1.7; 95 percent confidence interval=1.26 to 2.16; p<.02) and prostitution (OR=1.56; 95% CI=1.17 to 1.95; p<.03). CONCLUSIONS: HIV risk behaviors before incarceration were highly prevalent among the women in this study. Rates of PTSD, depression, and dysthymic disorder were also high. PTSD was associated with prostitution and receptive anal sex, and the disorder may contribute to high rates of risky sexual behavior. Targeted HIV risk reduction efforts among women prisoners should include evaluation for PTSD; conversely, women prisoners with a diagnosis of PTSD should be evaluated for prior HIV sexual risk behaviors.     

Depression, suicidal ideation and STD-related risk in homeless older adolescents

Goals of this study were to examine the frequency of depression and related constructs of suicidal ideation and hopelessness in a sample of homeless older adolescents and their associations with behaviors that may increase the risk of sexually transmitted disease (STD). Diagnostic interviews and blood/urine samples were obtained from 523 homeless adolescents (mean age=17.8). Overall, 12.2 per cent had a current DSM-IV diagnosis of major depression and 6.5 per cent had dysthymia, with higher rates for female and older participants. Depression appeared to precede rather than follow homelessness and was associated with biologically verified STDs (in older participants), infrequent condom use, a non-heterosexual orientation (in older participants), and lifetime homosexual experience. Unlike depression, suicidal ideation and hopelessness were associated with higher rates of intravenous drug use but lower rates of multiple sex partners and, in young homeless women, less sexual coercion. Depression is frequent in homeless older adolescents and has a complex association with STD-related behaviors.     

Bladder and sexual function among women with multiple sclerosis

OBJECTIVE: Genitourinary dysfunction is common in women with multiple sclerosis (MS), yet few studies have evaluated the association between bladder and sexual dysfunction in these women. The aim of this study was to determine factors, including demographic and bladder function, associated with sexual dysfunction in a sample of women with MS. METHODS: One hundred and thirty-three women with MS completed questionnaires related to overall heath status, bladder function and sexual function. Response frequencies and percentages were calculated for questionnaire responses. Multivariate logistic regression analyses were performed to determine predictors of sexual dysfunction. RESULTS: Sixty-one per cent of the sample indicated that they had a problem with bladder control. Forty-seven per cent of respondents indicated that their neurological problems interfered with their sex life. Over 70% of the sample reported that they enjoyed, felt aroused and experienced orgasm during sexual activity. Not having a sexual partner and the indication of bothersome neurological problems were the best predictors of sexual dysfunction. Interestingly, patients bothered by their urge incontinence had higher levels of orgasm compared to women not bothered by urge incontinence. CONCLUSIONS: Although over half of the women reported voiding symptoms, most still enjoyed, felt aroused and could experience orgasm. Neurological symptoms and lacking a sexual partner emerged as the best predictors of sexual dysfunction. Urge incontinence may not be a risk factor for an orgasm. Our findings elucidate the complex nature of sexual dysfunction in women with MS.     

Perceptions of local HIV/AIDS prevalence and risks for HIV/AIDS and other sexually transmitted infections: Preliminary study of intuitive epidemiology

Background: Risk perceptions are theoretically important in predicting health behavior but have only shown modest evidence in predicting sexual risk behavior.Purpose: Our purpose is to investigate whether perceptions of the local prevalence of disease serve as a predictor of health behavior, particularly behaviors associated with infectious diseases such as HIV/AIDS.Methods: Four hundred eighty-seven men and 236 women receiving diagnostic and treatment services at a sexually transmitted infections (STI) clinic in a moderate-size U.S. city completed anonymous surveys of perceived prevalence of HIV/AIDS and other STI and sexual risk and protective behaviors.Results: Participants who estimated a lower AIDS burden in their city relative to other U.S. cities demonstrated greater numbers of sex partners, higher rates of sexual risk practices, and higher rates of STI. They were also less likely to have been tested for HIV.Conclusions: This initial study of intuitive epidemiology suggests that STI clinic patients may have a sense for the relative burden of AIDS in their city and estimates of local disease prevalence may predict sexual risk behaviors. The National Institute of Mental Health Grant R01-MH61672 supported this research.