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)

Maternal lifestyle and pregnancy outcome in Jamaica: the effects of cigarette and marijuana smoking, alcohol use and sexual activity

Cigarette smoking, marijuana and alcohol use, and coital activity have been investigated for effect on foetal birth weight and gestation chiefly in developed countries. Apart from the relationship between cigarette smoking and heavy alcohol intake and growth retardation, the evidence for poor birth outcome is controversial. Little is known of the effect of these lifestyle factors in developing countries where poor pregnancy outcome is common. Using data from a population based perinatal study in Jamaica, the effect of lifestyle factors was ivestigated in 8486 babies. Data collected by midwives at birth included the date of the last menstrual period, socio-demographic characteristics and frequency of tobacco, marijuana and alcohol use during pregnancy, as well as coital frequency at quickening and at delivery. Babies were weighed and measured. Live birth outcomes investigated were low birth weight, preterm birth and growth retardation, with population rates of 10.1 percent, 8.7 percent and 9.7 percent, respectively. Data were processed using SPSS and BMDP statistical packages. The prevalence of cigarette, marijuana and alcohol use was 7.0 percent, 2.1 percent and 16.4 percent respectively. 74 percent and 27 percent of women were having sexual intercourse at quickening and in the week prior to delivery, respectively. Apart from coital frequency at quickening, life style factors were strongly associated with each other. All life style factors were associated with social class. On univate analysis, significant associations were found between cigarette smoking and low birth weight (p,0.04) and growth retardation ,0.05). Association between marijuana use and low birth weight and between alcohol use and lower incidence of preterm birth failed to reach significance (p=0.05, p=0.16). When stratified by frequency of use, there was a significant trend in both cases (p<0.05, p<0.04). After controlling for socio-demographic characteristics and other life style factors, associations were maintained between cigarette smoking and low birth weight. Foetal effects of maternal cigarette smoking are present even in al low prevalence country. The effect of marijuana use is less conclusive, but the data suggest that this activity may be detrimental to the foetus. (Au)

Association of pregnancy-induced hypertension with sexual activity in primigravidae: a preliminary report

Prolonged exposure to semen prior to conception has been associated with a decreased risk of developing pregnancy-induced hypertension. In this study, 257 primigravidae were interviewed about total duration of sexual activity and sexual cohabitation with the father of the index pregnancy and number of sexual partners prior to conception. Each patient was placed in one of three groups: normotensive, transient hypertension and pre-eclampsia. Median duration of cohabitation was significantly less in patients with transient hypertension (9 months) than in normotensive patients (19 months) and those with pre-eclampsia (33 months), whereas total duration of sexual activity was similar in all three groups. Also, significantly more patients with transient hypertension had only one partner (51.5 percent), when compared with those in the normotensive (29.7 percent) and pre-eclamptic (26.7 percent) groups. Further analysis revealed that having one partner prior to conception significantly increases the risk of developing transient hypertension (relative risk 2.19), but not of developing pre-eclampsia. The results suggest that minimal exposure to semen, and having only one partner prior to conception in primigravidae may be risk factors for the development of transient hypertension but not for pre-eclampsia. In addition, the differences in the results for transient hypertension versus pre-eclampsia suggest different pathophysiological mechanisms for the two disorders. (AU)

Determinants of condom use among gay and bisexual men in Jamaica - abstract

Ano-genital intercourse plays a major role in the homosexual transmission of HIV. A random sample of 101 gay and bisexual men aged 15-61 years was surveyed using a questionnaire. This study sought to assess age, knowledge and beliefs (identified in the Health Belief Model) as determinants of condom use. Ninety-seven per cent identified AIDS as a very serious problem and 92 percent endorsed consistent use as an effective measure to reduce the risk of HIV infection. Only 45.5 percent perceived themselves to be at risk of HIV infection. Eighty-seven per cent of the respondents reported being engaged in ano-genital sex in the past year. The levels of consistent condom use (always) for insertive and receptive ano-genital sex were 52.6 percent and 50 percent, respectively. Age and knowledge along with health beliefs relating to personal susceptibility to HIV infection, severity of AIDS, effectiveness of condom use, and cues to action, such as seeing or knowing someone with AIDS, did not predict condom use. Subjects who reported feeling "uncomfortable" or "afraid" when they asked their partner to wear a condom were more likely than those who reported "comfortable" to have never used condoms (P<0.0001). Perhaps those subjects who reported never using condoms lack the skills to negotiate condom use. Intervention programmes should therefore focus more on developing and enhancing skills and self-esteem (AU)

Does maternal behaviour influence the risk of perinatal death in Jamaica?

Features of behaviour of mothers of singleton perinatal deaths collected over the 12-month period from 1 September 1986 to 31 August 1987 were compared with 9919 mothers of singleton infants born in September and October 1986 and surviving the first week of life, as part of the Jamaican Perinatal Mortality Survey. For perinatal deaths as a whole, and in the presence of maternal age and social environmental features, logistic regression analyses showed that the following were independently related with higher risk of mortality: (1) deliberately trying to get pregnant; (2) ever having used Depo Provera; (3) not drinking alcohol in pregnancy; and (4) smoking cigarettes in pregnancy. There were no associations with coital frequency, ever using the contraceptive pill or smoking ganja (cannabis). Deaths were classified using the Wigglesworth scheme, and separate analyses carried out for the three major groups-antepartum fetal deaths, deaths from immaturity and deaths from intrapartum asphyxia. Antepartum fetal deaths were at increased risk if (1) mothers were deliberately trying to get pregnant or (2) they had ever used Depo Provera. Deaths from immaturity were not associated with any health behaviour variables. Deaths from intrapartum asphyxia were more likely if (1) the mother was deliverately trying to get pregnant or (2) she had never used and used and intrauterine contraceptive device (Summary)

Risk factors for carcinoma of the uterine cervix in Jamaican women

Risk factors of cervical cancer include early age at coitus, multiple sexual partners and antibodies to herpes simplex virus, type 2 (HSV-2). To examine the interrelationships of these risk factors, a comparison was made between 78 histologically confirmed cancer cases (stages O-IV) and 151 control women in Jamaica. The rank of order of the percentages of control women with low socioeconomic status, first coitus before 20 years of age, first pregnancy before 20 years of age and more than two sexual partners were: 77, 97, 65, and 76 respectively. The percentage of women with cancer who had first coitus before 20 years of age (77) and 2 or more partners (55) were lower than that of controls. A third factor associated with cervical cancer is the presence of HSV-2 antibodies. The age-specific prevalence of HSV-2 antibodies varied from 7 percent to 32 percent in women aged 21-69 years. An increase in prevalence of HSV-2 was observed with increasing age. The age-adjusted prevalence was 11 per cent. The age-specific occurrence of HSV-2 antibodies in cancer cases were not statistically significant as compared with matched controls (p> 0.01). The data suggest that infection with HSV-2 is a covariable of venereal factors, and the role of the virus in the genesis of some cases of cervical cancer in Jamaican women may not be excluded (AU)

Spontaneous spinal epidural haematoma

A case of the rare syndrome of spontaneous spinal epidural haematoma is reported. In this patient, the initiating factor appeared to be the vasopressor responses associated with orgasm. A plea is made for greater awareness of this condition in patients with acute transverse myelitis with no obvious cause (AU)

Injury to the posterior vaginal fornix during intercourse

Four cases of injury to the posterior fornix during intercourse have been presented. Aetiology, incidence, diagnosis and treatment have been discussed. Cases which were presented all bled heavily and were largely misdiagnosed when first seen. It would seem that there is a place for a greater awareness of this condition, especially in countries with large Negro populations. (Summary)