Prevalence of Sexually Transmitted Diseases and Risk Behaviors from the NIMH Collaborative HIV/STD Prevention Trial

ABSTRACT

This cross-sectional study describes the baseline prevalence and correlates of common bacterial and viral sexually transmitted diseases (STDs) and risk behaviors among individuals at high risk for HIV recruited in five low- and middle-income countries. Correlations of risk behaviors and demographic factors with prevalent STDs and the association of STDs with HIV prevalence are examined. Between 2,212 and 5,543 participants were recruited in each of five countries (China, India, Peru, Russia, and Zimbabwe). Standard protocols were used to collect behavioral risk information and biological samples for STD testing. Risk factors for HIV/STD prevalence were evaluated using logistic regression models. STD prevalence was significantly higher for women than men in all countries, and the most prevalent STD was Herpes simplex virus-type 2 (HSV-2). HIV prevalence was generally low (below 5%) except in Zimbabwe (30% among women, 11.7% among men). Prevalence of bacterial STDs was generally low (below 5% for gonorrhea and under 7% for syphilis in all sites), with the exception of syphilis among female sex workers in India. Behavioral and demographic risks for STDs varied widely across the five study sites. Common risks for STDs included female gender, increasing number of recent sex partners, and in some sites, older age, particularly for chronic STDs (i.e., HSV-2 and HIV). Prevalence of HIV was not associated with STDs except in Zimbabwe, which showed a modest correlation between HIV and HSV-2 prevalence (Pearson coefficient = .55). These findings underscore the heterogeneity of global STD and HIV epidemics and suggest that local, focused interventions are needed to achieve significant declines in these infections.     

A descriptive analysis of students seeking HIV antibody testing at a university health service.

The authors describe 255 students who voluntarily sought human immunodeficiency (HIV) antibody testing at a university health center. Fifty-nine percent of the students were women, their average age was 22.6 years, and they had low reported rates of unintended pregnancy and sexually transmitted diseases (STDs). Nearly one third of the students had been previously tested for HIV. Approximately 40% of students described sexual activities that placed them at some risk for HIV infection and other sexual problems, such as unintended pregnancy and STDs. None of the students expected that their HIV test results would be positive, and that proved to be the case. Results of this study are discussed with a view to the role of HIV testing and counseling in campus AIDS programming.     

An impact evaluation of student teacher training in HIV/AIDS education in Zimbabwe

Zimbabwe introduced a nation-wide program to teach AIDS education in 1994. This paper evaluates changes in student teachers' level of knowledge about transmission, symptoms and prevention of STDs and HIV/AIDS; their attitude towards persons living with AIDS; and their sensitivity to the impact of the epidemic and to discussing and teaching about these issues. There was an increase in knowledge of HIV prevention and in teachers' ability to discuss reproductive health and sexual issues. However, as students were exposed to other HIV material outside the programme, not all of this change is due to the programme. Course attendance needed to be enforced and the curriculum needed to be updated with student participation. Peer educators and participatory techniques are needed to get students to internalise positive attitudes and behaviour. The education materials need to address the lack of female empowerment in making decisions and negotiating for safer sex.     

Male Migration,Women Left Behind,and Sexually Transmitted Diseases in Armenia

The effect of male circular labor migration on risks of sexually transmitted diseases (STDs) among women left behind has not been well studied. Our study examines this effect using data from a survey of 1,240 married women in rural Armenia, where international male labor migration has traditionally been very common. A multivariate comparison of women married to migrants and women married to non-migrants finds that the former, ceteris paribus, reported more STD symptoms, on average, and were more likely to report diagnosed STDs than the latter. However, in the case of STD symptoms, this effect is moderated by household income, as the predicted number of STD symptoms reported by migrants’ wives increases as income rises. The findings illustrate the complex tradeoffs that migration entails for left-behind women and are interpreted in the context of the literature on gender, migration, and STDs.     

Testing a New Measure of Sexual Health Knowledge and Its Connections to Students' Sex Education,Communication, Confidence,and Condom Use

ABSTRACT

This study investigates the nature of college students' sexual health knowledge, prior sex education coverage, and sexual communication and confidence. We created a new, comprehensive sexual health knowledge measure to assess 347 undergraduates' knowledge of reproductive health, contraception, condom use, sexually transmitted diseases (STDs), and HIV/AIDS. Overall, students demonstrated a fairly poor understanding of sexual health issues. Women were more knowledgeable than men, specifically on the topics of contraception and STDs. Prior exposure to sex education covering mainstream reproductive health issues or newer contraception methods was correlated with greater knowledge across all domains, particularly for men. Greater knowledge was also correlated with greater sexual assertiveness and confidence with condoms among women.     

Temporary Migration and The Spread of STDs/HIV in China: Is There A Link?1

Using data from the literature and a specially designed community‐level survey, this article examines the link between temporary migration and the spread of HIV/STDs in China. The results suggest that temporary migrants not only are overrepresented among people with STD/HIV risk‐taking behaviors, but also account for disproportionately more STD patients and persons infected with HIV. It is imperative that STD and AIDS prevention intervention and education programs in China target temporary migrants. More research is needed that focuses on the underlying mechanisms by which the process of temporary migration renders migrants vulnerable to STD/HIV risk‐taking behaviors.     

Barrier versus oral contraceptive use: a study of female college students

Although they provide birth control and are easier to use, oral contraceptives (OCPs) are not the preferred approach to preventing sexually transmitted disease (STD). Do the knowledge, attitudes, and experiences of oral contraceptive users place them at greater risk for STDs than those who employ barrier methods? This study examined differences between sexually active female college students (ie, those who reported ever having had vaginal intercourse) who used OCPs and those who employed barrier methods of contraception at the time of their most recent intercourse. The authors analyzed HIV- and other STD-related knowledge, attitudes, and behaviors from three consecutive annual health surveys of young women about to begin their first year of college. Findings showed barrier and OCP users to be comparable in knowledge about the effectiveness of various contraceptive methods in protecting them against STDs, perceived personal susceptibility to HIV, and experiences with alcohol before sexual intercourse. Oral contraceptive users, compared with those in the group who used barrier methods, reported a greater number of recent partners (p less than .03) and greater perceived vulnerability to STDs (p less than .03). Student healthcare providers must develop creative educational strategies to encourage simultaneous use of both oral contraceptives and barrier methods to protect students against STDs and pregnancy.     

Does funding for HIV and sexually transmitted disease prevention matter? Evidence from panel data

Since the onset of the AIDS epidemic, the Centers for Disease Control and Prevention (CDC) has allocated several billion dollars for the prevention of HIV and other sexually transmitted diseases (STDs) in the United States. Using state-level data from 1981 to 1998, the authors found that greater amounts of prevention funding in a given year are associated with reductions in reported gonorrhea incidence rates in subsequent years. The authors conclude that funding for STD and HIV prevention, on the whole, appears to have a discernable impact on the incidence of STDs.     

Coerced Sexual Experiences Among Adolescent Substance Abusers: A Potential Pathway to Increased Vulnerability to HIV Exposure

This study describes the forced sexual experiences, serious internalizing problems, risky sexual behavior, and alcohol-related correlates of risky sexual behavior of 120 substance abusing adolescents and young adults (87 men, 33 women; mean age = 17.2 years) undergoing treatment. Prior coerced sexual experiences were associated with suicidal thoughts and attempts, higher levels of risky sexual behaviors, avoidance motives for drinking, and sexual decision-making conducive to risky sexual behavior. Sexual coercion was associated with patterns of sexual behavior and alcohol use that potentially increase vulnerability to HIV exposure. Social workers can play a number of significant roles in addressing ongoing psychological distress associated with sexual coercion among these predominantly female adolescents. Therefore, effective social work practice should enhance treatment effectiveness and reduce risk for a range of maladaptive outcomes including exposure to sexually transmitted diseases (STDs) and revictimization.     

Getting your partner to use condoms: Interviews with men and women at risk of HIV/STDs

Data from individual semistructured interviews with 90 young heterosexual couples were analyzed to identify strategies that men and women at risk of HIV/STDs would use to influence their partners to use condoms for the purpose of disease prevention. In addition, we explored whether participants thought influencing strategies would differ for pregnancy prevention. Content analysis of the interview data indicated that participants would use the following verbal strategies: persuading/suggesting, commanding/asserting, and threatening to withhold sex. Several participants, particularly those who had recently used condoms with their partners, reported that they would also use non‐verbal strategies involving condoms themselves (e.g., putting a condom on, buying or getting condoms, or presenting a condom to their partner). Many participants believed that they would use a different strategy for pregnancy prevention because it would be easier to convince a partner to use condoms for that purpose.     

Women at Risk for Human Immunodeficiency Virus

This article reports results from a survey among women at risk for contracting human immunodeficiency virus (HIV) as well as transmitting it in a vertical (to offspring) and horizontal (sexual partner or intravenous [IV] drug usage) mode. Little is known about the extent of HIV knowledge, sexual behaviors and IV drug usage for women at risk for HIV infection. The sample (N = 620) consisted of Black (50.6%), Caucasian (28.7%), Hispanic (13.4%) and Haitian (5.0%) adult non-pregnant women from South Florida. Data concerning their drug usage, sexual behaviors and other risk factors for HIV infection are presented alone with their knowledge about HIV infection and acquired immunodeficiency syndrome (AIDS). The women had an adequate knowledge base about HIV and AIDS; however the results indicated that our sample was at risk due to the following risk factors: (1) unprotected sexual intercourse, both vaginal and anal, with men who were at high risk for HIV infection (i.e., men who were bisexual and/or used IV drugs); (2) IV drug usage by the woman themselves including needle sharing in "shooting galleries"; (3) the practice of prostitution by the women and; (4) the use of various non-IV drugs that have been shown to impair judgement and lower inhibitions regarding sexual practices. Results indicate differences in risk behaviors and knowledge about AIDS by race/ethnicity.     

“The Story of My Life”: AIDS and ‘Autobiographical Occasions’

Talk and ‘telling’ have assumed prominent roles in preventing HIV and promoting life with the disease at the start of the twenty-first century. Our concern in this paper is to show how social structures and circumstances shape the narrative productions of HIV positive patients whose lives are institutionally managed. We consider what ‘telling’ means when young women with few economic resources are encouraged or mandated to talk about themselves by case managers, researchers, therapists, welfare workers, and clinic staff. We organize our analysis around three such ‘autobiographical occasions’: disclosures to intimate partners prompted by agents of the state; employment opportunities in which women are hired to tell others about living with HIV as peer educators or outreach health workers; and research interviews. We argue that storylines about living with HIV have been laid down by powerful social actors whose illness experiences do not reflect those of many poor patients. These formulations constitute an ‘archive’ which organizes institutional practices and discourses. These matter not only because they provide patients with a language through which to render their actions meaningful, but because they shape the everyday experience of HIV outside the clinic, the welfare office, and the therapy session.

West and Central Africa

This article reviews scientific and other literature during the 1990s that links migration and mobility with the spread of sexually transmitted diseases (STDs), including HIV/AIDS. The focus is on key population groups linked to the spread of HIV and STDs in West and Central Africa: migrant laborers, truck drivers, itinerant traders, commercial sex workers (CSWs), and refugees. Countries with high emigration and immigration tend to have high levels of HIV infection, with the exception of Senegal. The main destination of immigrants are Senegal, Nigeria, and Cote d'Ivoire in West Africa and Cameroon, Congo, Gabon, and Congo in Central Africa. The risk of infection and the spread of HIV is variable among migrants. There is little in the literature that substantiates hypotheses about the strong association between migration and HIV-positive status. Information is needed on the duration, frequency of return visits, living conditions, sexual activities with multiple partners, and information before departure, along the routes, at final destination, and at the time of returns. Action-based research in five West African countries (Burkina Faso, Cote d'Ivoire, Mali, Niger, and Senegal) should produce results in late 1998. Comparable studies in Central Africa are unknown. Regional studies should be complemented by local studies. Prevention would benefit from studies on the relative size of these five population groups by geographic location.     

Tackling HIV and AIDS with faith-based communities: learning from attitudes on gender relations and sexual rights within local evangelical churches in Burkina Faso,Zimbabwe, and South Africa

The AIDS pandemic in Africa is devastating the continent. The institution of marriage does not appear to be protecting women – in some countries rates of infection among married women are higher than those among unmarried, sexually active women. Recognising that unequal gender relations are a driving force behind the AIDS pandemic, this article explores the position of local evangelical churches in Africa with respect to gender relations and sex, and the implications for HIV and AIDS. Based on desk and field research carried out by the UK-based NGO Tearfund, the findings indicate that these churches were largely silent on the issue of gender and sex, or were reinforcing traditional values which contribute to HIV infection. In a number of countries, the church seems to have failed to provide leadership to young people, especially young women, facing huge pressure to be sexually active. Strategies for responding are outlined.

In some heavily affected countries, married women have higher rates of HIV infection than their unmarried, sexually active peers. Kofi Annan, UN Secretary General, World AIDS Day 2004.

Adhering to the teachings of the Church, we determined to engage more deeply in challenging cultures and traditions which stifle the humanity of women and deprive them of equal rights. We agreed that our greatest challenge is to nurture and equip our children to protect themselves from HIV, so that we can fulfil the vision of building a generation without AIDS. Pastoral Letter from the Primates of the Anglican Communion, 27 May 2003.

All the pastors’ wives had never seen a condom as it is seen as a tool for unfaithful wives. NGO worker, Burkina Faso.     

Sexually transmitted diseases and migration

Sexually transmitted diseases (STDs) are communicable diseases transferred mainly through sexual contact. With more than 20 pathogens known to be spread by sexual contact, STDs are the most common notifiable infectious diseases in most countries. Despite some fluctuation in their incidence, STDs continue to occur at unacceptably high levels. For most notifiable STDs, the highest rates of incidence are found in 20-24 years olds, followed by people aged 25-29 and 15-19. Among sexually active teenagers, the highest incidence of STD infection is among the youngest teens. For most STDs, the overall morbidity rate is higher for men than for women. STD control programs need to be designed and implemented with the understanding that migration has always been linked with STD. Sexual preference, marital status, socioeconomic status, place of residence, prostitution, migration, principal STDs, populations at risk, and prevention and control measures are discussed. Strategies to prevent STD transmission must remain flexible in order to adapt to prevailing conditions, with adequate clinical services being central in controlling STDs.     

Gendered Economic,Social, and Cultural Challenges to HIV/AIDS Prevention and Intervention for Chinese Women

ABSTRACT

China is experiencing the most rapidly expanding HIV prevalence in the world, with the percentage of Chinese women living with HIV/AIDS also increasing significantly. Chinese women's risk of HIV infection is heavily influenced by patriarchal cultural beliefs, Confucian doctrines, and rapid social and economic changes in China. Chinese women generally have a low level of awareness of HIV/AIDS. With inherent inferior social status and economic disadvantage, their vulnerability to HIV infection is heightened by adverse impacts of massive rural-to-urban migration, explosion of the commercial sex industry, and prevalence of gender-based violence. In order to target HIV/AIDS prevention and treatment programs for Chinese women, their specific needs and gendered obstacles must be addressed and tackled. These include strategies that aim to fight against poverty, improve education, enhance HIV/AIDS awareness, facilitate new life-skills acquisition and behavior change, make available woman-centered services for testing and treatment of HIV, and eradicate gender-based discrimination and violence. There is also an urgent need to further develop various public health infrastructure in China, especially in remote and rural areas. The pool of gender experts in China should also be expanded to conduct a thorough gender analysis and design a national response to address the evolving HIV/AIDS epidemic in Chinese women.     

A Model Program for Increasing Treatment Access for African American Women Who Use Crack Cocaine and Are at Risk of Contracting HIV

ABSTRACT

In the United States, the threat of HIV/AIDS to African-American women's health has become the focus of much concern. This article describes a federally funded community-based program that provides services to African-American women at risk for HIV/AIDS in Nashville, TN. This program provides a culturally relevant set of interventions specific to crack cocaine users aimed at reducing substance use and HIV/AIDS risk behaviors. The model is important to the continued development of culturally relevant interventions that are vital to stemming the disproportionate rates of HIV/AIDS within the African-American community by ensuring treatment access to all populations.     

Health belief factors and dispositional optimism as predictors of STD and HIV preventive behavior

Identifying factors predictive of youth's engaging in preventive behaviors related to sexually transmitted diseases (STDs) and HIV remains a prominent public health concern. The utility of the Health Belief Model (HBM) continues to be suggested in identifying preventive behaviors. This study sought to examine the full HBM, including self-efficacy, with regard to STD and HIV preventive behavioral intentions in college students. Self-efficacy was identified as the primary predictor for each of the behavioral intentions (condom use, STD testing, and HIV testing), whereas response efficacy was only predictive of testing intentions. Inconsistent with HBM assumptions, perceived HIV severity was negatively related to HIV testing intentions. Students who perceived HIV as high in severity were less likely to intend to obtain HIV testing. Overall, the utility of the HBM in predicting college students' sexual preventive behavior was unsupported. An argument for a change in the direction of research, away from the continued emphasis on the study of cognitive variables, is made.     

Female Tourists, Casual Sex, and HIV Risk in Costa Rica

This paper describes the involvement of young female tourists who visit rural Costa Rica with gringueros (i.e., local men who actively seek relationships with foreign women), and explores the implications of these relations, which gringueros see as outlets for sexual adventure, for sexual behaviors that could contribute to the spread of HIV/AIDS. The findings highlight the need to use tourism-related locales to implement HIV/AIDS awareness strategies targeted at women tourists, gringueros, and other local youth.

Women in India: The Context and Impact of HIV/AIDS

ABSTRACT

The response to the HIV/AIDS epidemic on the Indian subcontinent has been hampered by several factors, including societal stigma, lack of educational resources, lack of economic opportunities, and the competing priorities for a nation just growing and developing an infrastructure for education, industry, and health. In particular, Indian women are silent victims in this epidemic because they do not readily have a respected voice in decision making and priority setting for the government. The epidemic is increasingly affecting and infecting Indian women (e.g., female commercial sex workers, married women, and pregnant women). The status of Indian women has placed them at extreme disadvantage because India is a country with socially progressive laws but has been slow to change its social norms. The reported HIV prevalence is low although many researchers agree a large amount of underreporting occurs. For India to address this emerging epidemic among women appropriately, it should focus on three intervention areas: (1) short-term solutions such as treatment options for those already infected with HIV to prevent further infection to sexual partners and children; (2) intermediate solutions such as education for those who are uninfected but engaging in behaviors that may put them at risk, such as injection drug use, engaging in commercial sex work, engaging in extramarital sexual relations, and having sexual partners who are not monogamous; and 3) long-term solutions such as addressing the root causes of inequality (e.g., disparities in education and employment and unwillingness to change social norms).