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.     

Men,Gender, and Health: Toward an Interdisciplinary Approach

Abstract

The anatomy and physiology of the ears, nose, and sinuses are reviewed. Diseases and injuries typically associated with water sports are discussed, with emphasis on pathophysiology, treatment, and preventative measures.

“Screening for Chlamydial Infections in Women Attending Family Planning Clinics: Evaluation of Presumptive Indicators for Therapy,” JULIUS SCHACHTER, EILEEN STONER, and JEANNE MONCADA. Chlamydia trachomatis was recovered from the cervices of 9.8 percent (268/2,729) of women attending seven family planning clinics. The infection rate varied from 5.5 percent to 22.5 percent in different clinics. Chlamydial infection could be associated with younger age, nulliparity, being black and use of oral contraceptives. Most (70 percent) of the chlamydial infections were inapparent and presumptive indicators for antichlamydial therapy that are useful for symptomatic women will not make a major impact on this reservoir. It is concluded that chlamydial cultures are needed to deal with the high prevalence of these infections. (Western Journal of Medicine 1983 Mar;138:375–379.)     

High-Risk Sexual Behavior Among Students of a Minority-Serving University in a Community With a High HIV/AIDS Prevalence

Objective: The authors used a stratified cluster sampling design to inform campus sexually transmitted diseases prevention programs. Participants and Methods: They conducted a cross-sectional study of students (N = 1,130) at a large, urban, minority-serving university in South Florida using the 2004 National College Health Assessment Survey instrument. Results: Of the 1,130 participants, 14.0% reported risky sexual behavior (having more than 1 sexual partner in 1 year and not using a condom the last time they had vaginal intercourse), and 11.9% reported consistent risky sexual behavior (having more than 1 partner in 1 year and not using condoms most or all of the time during the past 30 days). In multivariable analysis, past-month alcohol use had the strongest independent association with both risky and consistent risky sexual behavior. Illicit drug use was marginally significant in both models. Conclusions: Administrators should address the use of alcohol and other drugs on campus in planning interventions to promote safe sexual behavior.     

Recruitment Strategies and Motivations for Sexually Transmitted Disease Testing Among College Students

Objective The authors evaluated procedures for recruiting college students for sexually transmitted disease (STD) testing as part of a research study examining the impact of HSV serologic testing. Participants A convenience sample of 100 students was drawn from students aged 18 to 35 years enrolled at one university in a mid- Atlantic state between September 2004 and March 2006. Methods: Six strategies were used to recruit students for participation in the study. Upon enrollment, participants were asked where they heard about the study. Students were also asked about their motivations for participation. Results: Findings show that a significant recruitment strategy involves targeting places where students seek health care. Other effective strategies include those where information is directly provided to individuals. Most students were motivated to participate because of a possible past exposure to herpes simplex virus 2. Conclusions: Targeting places where students seek health care and educating students about STDs are important strategies for recruiting students for STD testing.     

Sexual Behaviors and Sexually Transmitted Diseases of Lesbians

ABSTRACT

The Boston Lesbian Health Project surveyed 1633 lesbians about their health status, health related behaviors and health problems. This paper reports on those parts of the questionnaire that dealt with sexual behaviors and sexually transmitted diseases. The sample was predominantly monogamous, but few had been in their present relationship for more than five years. Sexual practices were similar to those reported in previous studies of lesbians and to those reported in a study of heterosexual women. Sexually transmitted diseases were rare in women who had never had sex with a male partner. The majority of the sample did report a history of male sexual partners and therefore are at risk for abnormal pap smears and other sexually transmitted diseases.     

Correlates of Correct Condom Use Among High-Risk African American Men Attending an Urban STD Clinic in the South

ABSTRACT

The purpose of this cross-sectional study was to assess prevalence and correlates of correct condom use among high-risk African American men attending a publicly funded sexually transmitted disease (STD) clinic. Men 18 through 29 years of age and newly diagnosed with an STD were further assessed for study eligibility. Of 296 meeting eligibility criteria, 271 agreed to participate, thereby yielding a participation rate of 91.5%. Correct use, assessed by an index, was reported by 38%. Correct use was associated with having sex with three or fewer female sex partners, being in an exclusive relationship, not indicating problems with the fit or feel of condoms, and not being drunk/high while using condoms. The correct use of condoms among young African American men newly diagnosed with an STD may be a function of situational factors. These factors could potentially be addressed in the context of clinic-based behavioral intervention programs.     

Factors Influencing Condom Use and STD Acquisition Among African American College Women

Abstract

To identify factors that influence condom use and the risk of acquiring sexually transmitted diseases (STDs) among African American college women, the authors surveyed a sample of 123 sexually experienced undergraduate women at a state university. The college women who were older, had initiated sex earlier, or had more recent sexual partners were more likely than others in the study to report a history of an STD. The findings have implications for prevention and intervention programs for African American college women.     

Abstracts and reviews

Frank A. Beach (Editor): Sex and Behavior, John Wiley and Sons, Inc. New York, London, Sydney, 1965. 592 + x pages. Price: $8.75.

Richard F. Hettlinger. Living with Sex: The Student's Dilemma. The Seabury Press, New York, 1966.

The Hygienic Principles of Moses Maimonides. J. American Medical Association. Vol. 194, No. 13, page 86, December 27, 1965.

Eleanor Mears (Editor): Handbook on Oral Contraception. J. & A. Churchill Ltd., London, 1965, pp. xv, 107.

Lars Ullerstam: The Erotic Minorities. Introduction by Yves de St. Agnes; translated by Anselm Hollo. Grove Press, New York, 1966.     

Vaginal Douching Practices Among Women Attending a University in the Southern United States

Abstract

The authors assessed the frequency, characteristics, and motivational antecedents of vaginal douching practices among 125 White and 155 Black female college students. Overall, 40% of the students had ever douched and half of those women currently douche. Black women were most likely to be encouraged to douche by their mothers, whereas White women were more influenced by television advertisements. Among the sexually active women, being Black, using oral contraceptives, using spermicides, and being encouraged to douche by their mothers or by the media were independently associated with ever having douched. These associations were present among both Black and White women and were stronger when current douching was compared with never having douched. Women who were discouraged from douching by a physician or nurse were more likely to have stopped the practice. Douching is common, even among educated young women; nurses' and physicians' advice to stop douching appears to have a salutary effect.     

Rates of Asymptomatic Nonurethral Gonorrhea and Chlamydia in a Population of University Men Who Have Sex With Men

ABSTRACT

Objective: To evaluate a text message (SMS) program as a booster to an in-person alcohol intervention with mandated college students. Participants: Undergraduates (N = 224; 46% female) who violated an on-campus alcohol policy over a 2-semester period in 2014. Methods: The SMS program sent drinking-related queries each Thursday and Sunday and provided tailored feedback for 6 weeks. Response rates to SMS drinking-related queries and the associations between weekend drinking plans, drinking-limit goal commitment, and alcohol consumption were examined. Gender differences were explored. Results: Ninety percent of SMS queries were completed. Weekend binge drinking decreased over 6 weeks, and drinking-limit goal commitment was associated with less alcohol consumption. Compared with women, men had greater reductions in alcohol consumption when they committed to a drinking-limit goal. Conclusions: Preliminary evidence suggests that an SMS program could be useful as a booster for helping mandated students reduce weekend binge drinking.     

Risk Factors for Chlamydia Trachomatis Infection in a California Collegiate Population

Abstract

Chlamydia trachomatis infection in college students has not undergone a detailed large-scale evaluation. The authors undertook a cross-sectional study of 4,086 students enrolled on the campuses of California State University, Sacramento, and 3 local community colleges from fall 2000 through spring 2002. They used an outreach screening model to determine the presence of infection by testing urine for chlamydial DNA by polymerase chain reaction. Participants completed demographic and behavioral risk questionnaires and a chlamydia knowledge assessment. Overall, 3.4% of participants tested positive for infection. Screening of male and female students was evenly distributed and incidence rates for males (3.03%) and females (3.78%) were similar. Variables associated with significantly increased risk were younger than 25 years, ethnicity other than White, more than one sexual partner in the preceding year or a new partner in the preceding 2 months, and current symptoms. Innovative outreach programs to screen a majority of at-risk college students should be developed.     

Position Statement on Tobacco on College and University Campuses

Objective: The authors examined the feasibility of conducting serologic testing for the herpes simplex virus 2 (HSV-2) among university students and assessed the psychosocial impact of an HSV-2 diagnosis. Methods: The authors recruited a convenience sample of 100 students (aged 18-39 years) without a history of genital herpes from 1 university between September 2004 and March 2006. Participants received HSV-2 antibody testing by Focus ELISA and Western Blot assays and completed a questionnaire that addressed psychological functioning. Twenty-eight participants completed the questionnaire again at a 3-month follow-up visit. Results: The study revealed (1) low test-reliability in the student population, (2) that positive test results may cause a decline in psychological well-being, and (3) that substantial resources are required to support students with positive HSV-2 results. Conclusions: Test performance, psychological impact, and availability of resources for counseling students with positive diagnoses should be considered before implementing HSV testing programs.     

A pilot test of a self-guided,home-based intervention to improve condom-related sexual experiences,attitudes, and behaviors among young women

Objective: To conduct a pilot test of a brief, self-guided, home-based program designed to improve male condom use attitudes and behaviors among young women. Participants: Women aged 18–24 years from a large Midwestern University reporting having had penile–vaginal sex with two or more partners in the past 3 months. Sixty-seven enrolled; 91.0% completed the study. Methods: A repeated measures design was used, with assessments occurring at baseline, immediately post intervention (T2), and 30 days subsequent (T3). Results: Condom use errors and problems decreased, condom-related attitudes and self-efficacy improved, and experiences of condom-protected sex were rated more positively when comparing baseline with T2 and T3 scores. Further, the proportion of condom-protected episodes more than doubled between T1 and T3 for those in the lowest quartile for condom use at baseline. Conclusion: This low-resource, home-based program improved condom-related attitudes and promoted the correct and consistent use of condoms.     

Mate Availability and Women's Sexual Experiences in China

Data from the 1999-2000 Chinese Health and Family Life Survey were merged with community-level data from the 1982, 1990, and 2000 Chinese censuses to examine the relationship between the local sex ratio (number of men per 100 women) and sexual outcomes among women (N = 1,369). Consistent with hypotheses derived from demographic-opportunity theory, multilevel logistic regression analyses showed that women are more likely to be sexually active, to have had premarital sexual intercourse, to have been forced to have sex, and to test positive for a sexually transmitted infection when there is a relative abundance of age-matched men in their local community. Education, birth cohort, and geographic location also emerged as significant predictors of women's sexual experiences.     

The GIG

SUMMARY

The GIG¹ is an innovative community based intervention which offers education regarding pregnancy and sexually transmitted infection (STI) risks and prevention in the context of a social event that is open to the adolescent community. This intensive, six hour intervention features live and recorded music, celebrities from local radio stations, raffles and prizes, and a number of educational activities providing instruction regarding pregnancy and STI risks and prevention. A total of 609 Latino adolescents completed matched pre and posttest measures. The increase in the total mean score from pretest to posttest was found to be statistically significant, as were the separate analyses for items related to pregnancy and those related to STIs. Information regarding specific attitudes and areas of knowledge are provided. Important intervention components related to the research literature are discussed along with areas of success, especially with regard to risk factors, and those in need of further attention in future intervention events. Recommendations for reinforcing and enhancing the GIG messages are presented along with implications of the findings for social work and health care professionals responsible for designing interventions for at-risk youth.     

Gay and Bisexual Men’s Experiences Using Self-Testing Kits for HIV and Rectal and Urethral Bacterial Sexually Transmitted Infections: Lessons Learned from a Study With Home-Based Testing

Abstract

Objectives: This study investigated the experiences of gay, bisexual, and other men who have sex with men (GBM) conducting HIV and sexually transmitted infection (STI) self-testing procedures. Methods: We analyzed mixed-methods data from 11 GBM who self-tested HIV-positive and 1,070 HIV-negative GBM who completed the HIV self-testing and STI self-sampling procedures. Results: Nearly all (99%) reported ease in urine-based STI self-sampling and most (90%) found rectal swab self-collection easy. Most (94%) checked their rapid-HIV self-testing results during the correct window (20-40 minutes), and nearly all (99%) trusted their HIV results. Conclusions: Recommendations for future self-testing procedures are provided based on findings from free-response data.     

Gender Differences in Reactions to Viewing Pornographic Vignettes

Abstract

A dilemma in the current pornography literature is whether one can classify some types of pornography as “degrading” and then accurately gauge individuals' motivations and reactions. One feature commonly cited as the best example of such degradation is the “cum shot.” In the current study, 375 male and female undergraduate volunteers were shown one of four video tapes: the original/unaltered condition, one that omitted visual images of ejaculation, and two that had the soundtrack altered to accentuate either degradation or acceptance themes. After viewing, participants completed the Ratings of Sexual Arousal (Mosher, 1987), Rating of Enjoyment, and Ratings of Degradation and Acceptance scales. Results revealed that men reported greater sexual arousal and enjoyment to all the videos and rated them as both more accepting and less degrading; the degrading voice-over decreased sexual arousal and enjoyment; and sexual arousal and enjoyment were positively related to ratings of acceptance. These results imply that an individual's interpretation of pornography has a strong impact on their subjective reactions.     

HPV Knowledge and Behaviors of Black College Students at a Historically Black University

College students are at high risk for human papillomavirus (HPV) infection, yet their knowledge and self-protective behaviors appear inadequate. Researchers who have measured HPV-related knowledge and behaviors in evaluating college intervention efforts pay secondary attention to black college students because this group generally represents only a small subset of samples of the broader college population. Objective and Participants The authors' purpose in this study was to examine HPV-related knowledge and behaviors in 351 black undergraduates attending a historically black southeastern university in the spring of 2003. Methods Voluntary and anonymous student participation was solicited in randomly selected undergraduate classes. Results Results indicated that most students lacked HPV awareness (64%), became aware of HPV largely after infection, and gained their HPV knowledge from a health-care provider or college class. The authors performed an analysis by gender and found that women were more knowledgeable about HPV than were men. Observed HPV-related knowledge and behaviors were similar to samples of the broader US college population. Conclusions Findings suggest a greater need for HPV intervention efforts for all college students, including those at black colleges.     

Difference in Condom Use Among Sexually Active Males at Historically Black Colleges and Universities

Black men who have sex with men (MSM) and black men who have sex with both men and women (MSMW) may not perceive themselves to be part of the larger gay community and hence may not heed prevention messages aimed at the community. Objective and Participants: To better understand the participants behaviors, the authors examined differences in condom use between black MSM/W (including MSM and MSMW) and men who have sex with women (MSW) at historically black colleges and universities (HBCUs). Methods: A paper-and-pencil questionnaire survey investigated sexual behaviors of 1,865 freshmen from 35 HBCUs during the 2001-2002 school year. Results: MSM/W were about 0.37 times less likely to always use condoms compared with MSW (adjusted odds ratio = 0.63, 95% confidence interval = 0.42-0.95). Sexual behavior, age at survey, total family income, and religion were also associated with condom use. Conclusions: These findings offer new directions for sexually transmitted disease and HIV prevention aimed at a highly marginalized population that remains at high risk for infection.     

Gabapentin shows promise for treating early alcohol withdrawal symptoms

Treating alcohol use disorder (AUD) with gabapentin in the early stages of alcohol withdrawal shows promise, according to a randomized clinical trial reported in JAMA Internal Medicine. The study, “Efficacy of Gabapentin for the Treatment of Alcohol Use Disorder in Patients With Alcohol Withdrawal Symptoms: A Randomized Clinical Trial,” by Raymond F. Anton, M.D., and colleagues, evaluated gabapentin versus placebo in 145 treatment‐seeking people who met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for AUD, 96 of whom were in recent alcohol withdrawal and randomized to treatment after three abstinent days. Daily drinking was recorded, and a heavy drinking blood marker was collected at baseline and monthly. The percentage of individuals with total abstinence and those with no heavy drinking days were compared between treatment groups. The participants had 83% heavy drinking days (four drinks a day for women, five for men) at baseline. More gabapentin‐treated individuals had no heavy drinking days (12 of 44 participants [27%]) compared with placebo (four of 46 participants [9%]), and more total abstinence (eight of 44 [18%]) compared with placebo (two of 46 [4%]). The prestudy high‐alcohol‐withdrawal group had positive gabapentin effects on no heavy drinking days and total abstinence compared with placebo, while within the low‐alcohol‐withdrawal group, there were no significant differences. These findings were similar for other drinking variables, where gabapentin was more efficacious than placebo in the high‐alcohol‐withdrawal group only. Gabapentin caused more dizziness, but this did not affect efficacy.