Aggressive sexual behavior of alcohol dependent men in Trinidad

The purpose of this study is to report the aggressive sexual behaviour of alcohol dependent men and its implications on clinical practice. A total of thirty women of male alcohol dependent partners were taken from the psychiatric clinic and matched with a control group of spouses of healthy non-drinking men for the variables of age, gender, ethnicity and social class. These groups were tested for sexually induced marks over a one month period, areas of the body that were marked, duration of the body marks and love making experiences. Our findings indicate that the spouses of alcohol dependent men are subjected to more aggressive and painful sexual experiences, more body marks in more regions that lasted an average of 7 days and more biting of body surfaces than wives of non-alcohol dependent men. These behaviours are interpreted as subtle signs of domestic violence which should not be ignored in clinical practice.

HIV risk behaviors of Latin American and Caribbean men who have sex with men in Miami, Florida, USA

OBJECTIVE: The goal of this study is to describe the sexual practices, drug use behaviors, psychosocial factors, and predictors of unprotected anal intercourse (UAI) in a sample of Hispanic men who have sex with men (MSM) born in Latin American and Caribbean (LAC) countries who currently reside in Miami-Dade County, Florida. METHODS: Hispanic MSM (N = 566) recruited from community and Internet venues completed a computer-assisted self-interview assessing sociodemographic factors, drug use, sexual behaviors, and psychosocial factors. We focused on the 470 men who were born in LAC countries, including Puerto Rico. We first examined separately, by country of origin, the sexual practices, drug use behaviors, and psychosocial factors of the sample. We then collapsed the groups and examined the factors associated with UAI in the previous 6 months for the entire sample of Hispanic MSM from LAC countries. RESULTS: In the previous 6 months, 44 percent of the sample engaged in UAI, and 41 percent used club drugs. At the multivariate level, psychological distress, higher number of sexual partners, club drug use, HIV-positive status at the time of immigration, and greater orientation to American culture were significantly associated with UAI in the previous 6 months. CONCLUSIONS: Many MSM born in LAC countries engage in HIV-related risk behaviors in the AIDS epicenter of Miami-Dade County, Florida. Culturally appropriate interventions should address these risk behaviors in this underserved population.

A study of the barriers to condom use: the women's perspective

This study was done to identify the barriers to condom use as experienced by a sample of women aged 15-49 years inclusive attending the General Medical (CUR) and Sexually Transmitted Infection (STI) clinics at two urban public health centres in St. James and Kingston & St. Andrew, Jamaica. A structured interviewer-administered questionnaire was applied to 267 respondents. Two (2) focus group discussions were conducted with women of the same target group. The findings show that while the women's knowledge of HIV/AIDS and the effectivenes of condoms was generally high, most of them had postitive attitudes and beliefs with respect to condom use, the majority did not use condoms consistently with either their regular or non-regular partners. Several women did not perceive a need to use condoms as they felt safe in their relationships - had only one partner, lived with the partner, and/or trusted the partner. Others cited partner refusal or the anticipation of negative response from the partner if they requested condom use. In addition, for some women, there were physical barriers to condom use - genital itching and irritation, dislike of how condoms feel and/or smell and the experience of decrease in sexual pleasure. About 47 percent of the women studied self reported a history of sexually transmitted infection (STI), with 50 percent reporting a history of STI in the preceding 12 months. These women with low condom use behaviour and risky sexual practices are at high risk of HIV/AIDS. The challenge, therefore, is for condom use promotion messages to be developed which target the women in particular. These should teach them proper HIV/STI risk assessment and condom use negotiation skills. They should also seek to educate the women as to how to overcome some of the physical barriers to condom use while still practising safer sex (AU)

Lifestyle factors and cervical dysplasia in Jamaica [abstract]

OBJECTIVE: Investigation of the impact of womens' sexual lifestyles on the development of cervical dysplasia. METHODS: Cases were recruited from women referred to the Colcoscopy Clinic, University Hospital of the West Indies, who had abnormal pap smears. Age-matched controls were recruited from the Gynaecology clinic. Women who consented to particpated were guaranteed anonymity and confidentiality and then interviewed on their sexual lifestyles. RESULTS: To date, 223 participants have been recruited: control (n=57), CIN I (n=69), CIN II (n=44), CIN III (n=32), Carcinoma (Ca) (n=9), and 12 cases whose colposcopy results are not yet available. One hundred and sixty-four of the 166 cases were diagnosed with the human papilloma virus (HPV). Twenty percent of the participants were unemployed, 21 percent were skilled/non-manual workers, while 21 percent were semi-skilled non-manual workers. Seven percent of the women occupied professional/managerial positions. There was no significant difference in age at first intercourse, number of lifetime sexual partners, number of biological fathers of their children, use of barrier contraceptives and pap smear history, between controls (n=57) and cases (n=166). When CIN I was grouped with the controls (n=126), there was a significant difference in the number of these women's lifetime sexual partners (4.1ñ2.4), compared to the women with CIN II-Ca (5.2ñ4.2), p=0.029. There was no significant difference in age between the two groups mean/SD (36.6ñ10.1 vs 36.8ñ10.5 yrs). CONCLUSIONS: The findings indicate that factors other than sexual behaviour play a role in the aetiology of cervical dysplasia in this population. (AU)

Sexually transmitted disease symptoms. A comparative analysis of male and female youth in Jamaica

Data from Reproductive Health Survey 1997 were used to examine symptoms of (STD) and sex behaviour of adolescents and young adults in Jamaica. Overall, nine per cent of the sample reported symptoms of STD in the year prior to the survey. Rates of high-risk sexual behaviours were high with one-fifth of the sample reporting multiple sex partners in the last three months. Slightly more than half reported condom use at coitus. Logistical regression analyses indicated that being older, having multiple sex partners, using condoms inconsistently with steady partners, and having cultural attitudes conducive to high-risk sexual activity were all associated with having symptoms of STD. These findings indicate that certain sub-populations are more likely to have symptoms of STD. STD prevention programmes should recognize the various risk groups at increased risk of STD and, ultimately, HIV. Interventions should be targeted to those who continue to have unprotected sex with multiple sex partners. In addition, cultural factors should be considered in the development of such prevention programes. (AU)

Risky behaviour in Jamaican adolescent patients attending a sexually transmitted disease clinic

The prevalence of sexually transmitted diseases (STD) and risky behaviour patterns were studied in 165 adolescents attending a STD clinic in Jamaica. A standardised structured questionnaire, clinical algorithms for STD and serological tests for HIV and syphilitic infection were applied. High prevalences of risky behaviour including young age at onset of sexual activity, especially in boys, (mean age 12.5 ñ 2.5 years); unprotected sexual intercourse (only 4 percent used condoms consistently); multiple sexual partners (mean 3.8 ñ 2.4 and 1.8 ñ 1.2 for boys and girls, respectively were found. Marijuana, used by 60 percent of the boys, was an independent risk factor for dysuria (adjusted Odds Ratio (OR), 2.0; 95 prcent CI, 1.6 - 3.4). Repeated episodes of STD (33 percent), coinfection with HIV (1.2 percent), syphilis (1.2 percent) and teenage pregnancy (13 percent) were prominent findings. Educational strategies which promote behaviour intervention at an early age, frequent and consistent use of condoms, abstinence or delayed onset of sexual activity are essential to reducing the HIV/AIDS and STD risk in adolescents in Jamaica.(Au)

HIV Voluntary Counselling and Testing in Community Health Services

Compares the effectiveness of voluntary counselling and testing for AIDS or reproductive health education among people in Kenya, Tanzania and Trinidad. Changes in sexual behaviour that occured among individuals in the counselling and testing group; Reports in this issue of the Lancet that deal with AIDS vaccines in developing countries and the cost-effectiveness of counselling and testing for HIV and AIDS.(Au)

Trends of AIDS in Guadeloupe (French West Indies): A longitudinal survey from 1998 to 1997

The study objective was to describe morbidity and mortality from HIV infection and the acquired immunodeficiency syndrome (AIDS) in Guadeloupe from 1998 to 1997 and to evaluate survival and prognostic factors. The HIV infected patients database of Guadeloupe included 1771 adult patients up to December 31, 1997. Annual incidence of AIDS defining illnesses were calculated and compared using Poisson regression. Survival analysis with log-rank test and multivariate analysis with Cox's model were performed for patients with AIDS. At the end of December 1997, 599 cases of AIDS (33.8 percent) and 367 deaths (20.7 percent) were reported. For 32.1 percent of the patients, AIDS was diagnosed before inclusion. Incidence of most AIDS-defining events decreased over time, especially after the introduction of protease inhibitor therapy. Before the introduction of protease inhibitors in September 1996, overall median survival after AIDS was 11.8 months (95 percent Confidence Interval (CI), 95 percent CI 10.2 - 14.1.) After this date median survival increased to 17.8 months (95 percent CI 18.6 - 22.5 ) and probability of survival was significantly higher for patients treated with protease inhibitor in combination regimen (mean 19.0 months. Standard deviation (SD) 1.3) compared to those who were not (mean 7.9 months, SD 0.6, p<0.0001). Prognosis factors of death after AIDS were older age (Relative Hazard, RH : 1.17, 95 percent CI 1.07 - 1.28), occurrence of two or more AIDS-defining events at the beginning of the disease (RH: 1.70, 95 percent CI 1.32 - 2.19), and a CD4 cell count less than 50/mm3 (RH: 2.33, 95 percent CI 1.71- 3.17). On the other hand, occurrence of AIDS during follow-up had a better prognosis (RH : 0.68, 95 percent CI 0.52 - 0.89) and protease inhibitor therapy was strongly associated with a longer survival (RH 0.26, 95 percent CI 0.13 - 0.53). We concluded that HIV infection in Guadeloupe was frequently diagnosed at the stage of AIDS. However, survival of patients and trends of major AIDS defining illnesses were more similar to the European pattern than to the Caribbean one, as a consequence of the availability of modern therapy.(AU)

Consistency of self-reports of sexual activity among young adolescents in Jamaica

Examines consistency of self-reports of sexual activity among young adolescents in Jamaica. Reporting of sexual activity, especially among boys; Highlight of limitations of relying on self-reported data to identify sexually active adolescents.(AU)

A survey of sexual behaviours and risk factors for HIV/STD infection among students at the University of the West Indies, St. Augustine campus

OBJECTIVE: To investigate the sexual behaviours of students resident in the dormitories at the St. Augustine campus (SAC), Trinidad, for the 1997-98 academic year. DESIGN AND METHODS: A questionnaire was administered to randomly selected students in each dormitory at the SAC. RESULTS: 180 students were selected randomly from the dormitory population and 169 questionnaires were completed (response rate = 93.9 percent). The median age of respondents was 21 years; males comprised 50.3 percent; 66.9 percent of respondents were sexually active; 31 percent of sexually active students used condoms consistently but 18.6 percent never used condoms. The most frequent reasons for not using condoms were: unavailable at the time (31.2 percent); monogamy (18.2 percent); use of the pill (5. percent). Inconsistent condom usage was not related to socio-economic status, marital status, marital status, level of study, or described religious behaviour. Other risk practices included sexual intercourse under the influence of alcohol (35.4 percent); sexual intercourse under the influence of drugs (12.4 percent) and more than one partner in the last year (38.9 percent). Many respondents admitted to multiple risk behaviour patterns. CONCLUSIONS: A high proportion of students resident in the dormitories at the SAC are sexually active and indulge in high-risk behaviour. Students who engage in several sexual risk practices have not personalized their risk of contracting HIV. Behaviour modification is needed.(Au)

Flap repair: an effective strategy for minimising sexual morbidity associated with the surgical management of vulval intra epithelial neoplasia

Objective: To assess the sexual function after local excision and flap repair for symptomatic vulval intraepithelial neoplasia (Vin). Study Design: A retrospective analysis of five sexually active women who had persistent, symptomatic VIN diagnosed in a dedicated tertiary referral vulval clinic and treated with local excision and flap repair. Sexual function was assessed using a modified version of the Sabbatsberg Sexual Self-Rating Scoring (SRS) system. Results: The mean age of the cohort was 32 years (range 30 to 51). Four patients had previously been unsuccessfully treated with local excision. Follow up ranged from 5 to 33 months. The SRS scores were 90, 90, 81, 72 and 25. Endogenous depression may explain this last score. There has been no recurrence of VIN. Conclusion: In sexually active women with symptomatic VIN III, a flap reconstruction should be considered in addition to local excision as the treatment of choice (AU)

Caribbean AIDS Explosion examined

Examines the factors causing the spread of AIDS in the Caribbean. Other issues raised at a conference on February 25, 2000; Estimated number of infected women; Statistics presented at the conference.(AU)

Evaluation of a sexuality program for young adolescents in Jamaica

Despite their increasing numbers, few of the sexuality education and pregnancy prevention programs in developing countries have been evaluated. This study, conducted in 1995-1997, assesses the impact of of a school-based sexuality education program, the Grade 7 Project, on 945 Jamaican seventh graders (aged 11-14) and their initiation of sexual activity and use of contraception at first intercourse, as well as the knowledge and attitudes that influence their behaviours. Using a quasi-experimental design, the studies measured the effect of the Grade 7 Project when the nine-month intervention was completed (short term) and one year after that (long term). Multivariate logistic regression analysis indicated that the project had no effect on initiation of sexual activity, but it had a positive short-term impact on the use of contraception at first intercourse (P = .08); adolescents in the intervention group were more than twice as likely to use contraception. The project also had a positive effect on several aspects of the adolescents' knowledge of and attitudes about sexuality and pregnancy. The modest impact of the Grade 7 Project is encouraging, as school-based sexuality education programs of limited duration rarely have a long-term impact. Moreover, competing socioeconomic and cultural forces in Jamaica encourage early sexuality and parenthood among adolescents. The use of more participatory teaching methods and smaller class sizes might strengthen the Grade 7 Project and enhance its impact. (AU)

Experiences and socialization of Jamaican men with multiple sex partners

One of the goals of the Acquired Immunodeficiency Syndrome (AIDS) control programme in Jamaica is to encourage persons to have a single sex partner. Before this can be achieved in men, it is important to identify the demographic characteristics as well as the sexual attitudes and socialization of men who have multiples sex partners. A national survey was conducted on sexual decision-making in Jamaica in which a random sample of 3,001 persons was selected for study and 2,580 (86 percent) interviewed 979 were men. The following analyses included the 769 men who where sexually active. Thirty-four percent (34 percent), 95 percent CI, 30.6-37.4 percent) of these men said that they were currently having sex with more than one woman. Although condom use was higher in men with multiple sex partners. 33 percent of them said that they never used condoms. Independent predictors of having multiple sex partners were: not being in a stable union; being raised by fathers only; and having a secondary school education. There was no significant association with church attendance or with occupation. Compared with other males, men who had multiple sex partners started having sex at an earlier age and were more likely to engage in high-risk sex behaviours such as having sex with prostitutes and abusing drugs prior to coitus. They were also more likely to believe in the use of sex as a means to control their partners and were less likely to think that being married or involved in a long-term relationship was important. These data must be taken into considerations by the AIDS control programme in Jamaica when formulating policies to promoted monogamy. There may also be a need to implement parenting support or education programmes for single men who raise their sons.(AU)

Among young Jamaicans, sex and childbearing often begin during adolescence

Reveals that among young Jamaicans, sex and childbearing often begin during adolescence. Comparison between the average age at the first intercourse of sexually experienced young women and that of men; Decision to have sex and use contraceptives; Reason cited for not using them

Knowledge, attitudes and practices of parents in a rural community with regard to the distribution of contraceptives to sexually active children under 16 years

Parents play a vital role in the lives of their children because they transmit and interpret acceptable cultural behaviour and help to mold the personality of their children. The study was designed to assess knowledge, attitude and practices of parents with regard to early sexual debut and distribution of contraceptive to sexually active children under 16 years. The study was designed to assess knowledge, attitude and practices of parents with regard to early sexual debut and distribution of contraceptives to sexually active children under 16 years. It was carried out on 75 parents in a rural district in Westmoreland. Two streets in the district were randomly selected and all parents with children aged 10-15 years were interviewed. Personal interviews were conducted by the researcher using pre-coded questionnaires. The results showed that while the majority of parents were knowledgeable about sexual activities in children, less that half knew about sexual activities in their children. They strongly disliked the practice of early sexual activities in children. Parental consent for contraceptive was not the preferred practice as the majority of parents expressed that they would not give consent for their children to access contraceptives but it must be made available so that children can access it when all else fail. Parents prefer to talk to and to counsel their sexually active children instead of offering contraceptives. The majority indicated that they are fulfilling their role as sexuality educators for their children (AU)

HIV infection rates and associated factors in high risk patients admitted to a psychiatric hospital in Trinidad and Tobago

We investigated the rate of HIV infection in patients at the St. Ann's psychiatric hospital in Trinidad and Tobago, and identified the demographic and clinical variables associated with infection. Patients admitted to the hospital were tested for HIV when details of their sexual history suggested that they might be at high risk of infection. We examined hospital records for the 1991-1995 period. During that time a total of 1,227 patients were tested, of whom 84 (6.9 percent) were confirmed positive for HIV. Since there was a total of 11,203 admissions over the period, the minimum infection rate for all patients was 0.75 percent. Among the high-risk group tested, being positive for HIV was associated with age (p=0.01) and ethnicity (p=0.003). The highest rates of infection were in the 15-44-year age group while the rates in patients of African and mixed ethnicity were higher than in East Indians. When the underlying diagnoses were examined, the highest rates were found in patients with substance abuse problems, especially those who abused cocaine (p<0.001). Patients who were VDRL reactive were also more likely to be HIV positive than other patients (p<0.001). These findings indicate that psychiatric patients are at greater average risk for HIV infection. Mental health specialists may need to be trained in sexual health counselling to facilitate preventive intervention for this high-risk group.(AU)