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No abstract available for this article.     

Priority interventions to reduce HIV transmission in sex work settings in sub-Saharan Africa and delivery of these services

Introduction

Virtually no African country provides HIV prevention services in sex work settings with an adequate scale and intensity. Uncertainty remains about the optimal set of interventions and mode of delivery.

Methods

We systematically reviewed studies reporting interventions for reducing HIV transmission among female sex workers in sub-Saharan Africa between January 2000 and July 2011. Medline (PubMed) and non-indexed journals were searched for studies with quantitative study outcomes.

Results

We located 26 studies, including seven randomized trials. Evidence supports implementation of the following interventions to reduce unprotected sex among female sex workers: peer-mediated condom promotion, risk-reduction counselling and skills-building for safer sex. One study found that interventions to counter hazardous alcohol-use lowered unprotected sex. Data also show effectiveness of screening for sexually transmitted infections (STIs) and syndromic STI treatment, but experience with periodic presumptive treatment is limited. HIV testing and counselling is essential for facilitating sex workers’ access to care and antiretroviral treatment (ART), but testing models for sex workers and indeed for ART access are little studied, as are structural interventions, which create conditions conducive for risk reduction. With the exception of Senegal, persistent criminalization of sex work across Africa reduces sex workers’ control over working conditions and impedes their access to health services. It also obstructs health-service provision and legal protection.

Conclusions

There is sufficient evidence of effectiveness of targeted interventions with female sex workers in Africa to inform delivery of services for this population. With improved planning and political will, services – including peer interventions, condom promotion and STI screening – would act at multiple levels to reduce HIV exposure and transmission efficiency among sex workers. Initiatives are required to enhance access to HIV testing and ART for sex workers, using current CD4 thresholds, or possibly earlier for prevention. Services implemented at sufficient scale and intensity also serve as a platform for subsequent community mobilization and sex worker empowerment, and alleviate a major source of incident infection sustaining even generalized HIV epidemics. Ultimately, structural and legal changes that align public health and human rights are needed to ensure that sex workers on the continent are adequately protected from HIV.     

Barrier Method Preferences and Perceptions Among Zimbabwean Women and their Partners

In Zimbabwe, adult HIV prevalence is over 25% and acceptable prevention methods are urgently needed. Sixty-eight Zimbabwean women who had completed a barrier-methods study and 34 of their male partners participated in focus group discussions and in-depth interviews to qualitatively explore acceptability of male condoms, female condoms and diaphragms. Most men and about half of women preferred diaphragms because they are female-controlled and do not detract from sexual pleasure or carry stigma. Unknown efficacy and reuse were concerns and some women reported feeling unclean when leaving the diaphragm in for six hours following sex. Nearly half of women and some men preferred male condoms because they are effective and limit women's exposure to semen, although they reportedly detract from sexual pleasure and carry social stigma. Female condoms were least preferred because of obviousness and partial coverage of outer-genitalia that interfered with sexual pleasure.     

Contraceptive use and associations with intimate partner violence among a population-based sample of New Zealand women

AIM: To outline the use of contraception among a representative sample of New Zealand women, and explore associations with intimate partner violence (IPV), and contraception and condom use. METHODS: Face-to-face interviews were conducted with a random sample of 2790 women who had ever had sexual intercourse, aged 18-64 years old in two regions (urban and rural) in New Zealand. Analyses were conducted using logistic regression and Wald chi(2) tests. RESULTS: Almost all women had used contraception at some point in their life, and almost one half of all women 18-49 years were currently using methods of contraception. Contraceptive use and methods varied significantly by location. Women who had ever experienced IPV were significantly more likely to report having ever used contraception, compared with women who had not experienced IPV (91% vs 85.2%). While having a partner who refused to use or tried to stop women from using a method of contraception was rare, it was significantly more common among women who had ever experienced IPV (5.4% vs 1.3%). CONCLUSIONS: Most women have used contraception at some point. Women who have ever experienced IPV were: more likely to have used contraception than women who have not experienced IPV, and to have had partners who refused to use condoms or prevented women from using contraception. Partner refusal may be a key indicator of IPV. These findings emphasise the importance of family violence screening at routine health consultations.     

Introduction:

No abstract available for this article.     

Sexual-risk behaviour among sexually active first-year students at the University of the Western Cape,South Africa

In South Africa, new HIV infections are concentrated among persons aged 15–24 years. The university population falls within this age group and are prone to higher-risk behaviours that place them at risk of acquiring HIV. In a study to assess this risk among sexually active students, we classified higher-risk sexual behaviours as not using condoms at every instance of sex, having had more than one sexual partner during the preceding 12 months, a relatively young age at first sexual intercourse (7–16 years), and experience of sexual violence and/or transactional sex. In total, 796 first-year students at the University of the Western Cape in Cape Town, South Africa, completed a self-administered questionnaire in 2006. The sample included 263 sexually active, unmarried students, aged 16 to 24 years. The responses showed that 62% did not use a condom for every instance of sex, 39% had two or more sexual partners in the previous 12 months, 53% had initiated sexual intercourse at a younger age (7–16 years), and 2% had ever exchanged money or gifts for sexual intercourse. Eight percent of the respondents said they did not give their consent or permission at initiation of first sexual intercourse. One in every 10 respondents claimed that they had ever been forced to have sexual intercourse, and 4% said that they had ever forced someone to have sexual intercourse. The sexually active students who reported an earlier age of initiation of sexual intercourse and having only one sexual partner during the last year were more likely to not use a condom every time, whereas the sexually active students that had experienced initiation of sexual intercourse while in an older age group (17–24 years) and who had two or more sexual partners in the last year were more likely to use a condom every time. Sexually active university students are in need of particular HIV-prevention interventions given their tendencies for poor condom usage and having multiple sexual partners.     

Patterns of Union Formation Among Urban Minority Youth in the United States

Since 1990, several large surveys of sexual behavior have been conducted. In addition to collecting general information on sexual histories, such as number of partners in the previous year and whether subjects ever used condoms, these studies collected information on sexual behavior with specific partners, or partnerships. The data are useful both for testing of substantive hypotheses about the determinants of behavior as well as for disease transition modeling. The objective of this paper is to use partnership histories to describe the union formation patterns of low-income youth living in Detroit. Data from the partnership histories will be used to illustrate the types of statistics that can be generated from these histories. Data will be presented on the number and types of unions (married/cohabiting, knew well, casual), the frequency and duration of these unions, the types of intercourse reported in each type of union, the patterns of mixing by age and ethnic group in each type of union, concurrency in unions, and condom use in unions.     

How well do male latex condoms work? Pregnancy outcome during one menstrual cycle of use

To evaluate the contraceptive effectiveness of male latex condoms, we assembled a cohort of 300 women relying on male latex condoms for contraception and followed them prospectively for one menstrual cycle. None of the 234 women who completed the study and reported at least one act of intercourse conceived (one cycle pregnancy rate 0%; 95% CI 0%–2%). Given the pattern of intercourse during the cycle and 3 different sets of conception probabilities for different days of the cycle, we would have expected between 32 and 36 pregnancies if no condoms had been used. Thus, the prevented fraction due to condom use (effectiveness) is 100% and the lower bounds of the 95% CI are between 89% and 90%. For this cohort, male latex condoms were an effective method of contraception. This cost-efficient approach of evaluating contraceptive effectiveness shows promise for post-marketing studies.     

Gay men's safer sex behavior: An integration of three models

This cross-sectional study explored gay men's sexual risk behavior from the perspective of three popular conceptual models, the health belief model, the theory of reasoned action, and social cognitive theory. Data were collected from sexually active gay men via anonymous questionnaire containing questions about sexual behavior and items related to the constructs comprising the three models. Using structural equation modeling techniques (LISREL 8), self-reported condom use was examined from the perspective of each theory. The results suggested that a substantial part of the variance in unprotected anal intercourse could be explained by conceptually analogous constructs common to these models. These constructs referred to the cognitive-affective reactions toward condoms and to the social context of using condoms. An additional variable unique to social cognitive theory, self-efficacy, added to the explained variance in the criterion above and beyond the variables that were common to the models. Relevant variables from the three theories were integrated into an expanded self-efficacy model.