RESUMO
OBJECTIVES: Young black women are disproportionately affected by sexually transmitted infections (STI) in the UK, but effective interventions to address this are lacking. The Young Brent Project explored the nature and context of sexual risk-taking in young people to inform the translation of an effective clinic-based STI reduction intervention (Project SAFE) from the USA to the UK. METHODS: One-to-one in-depth interviews (n = 37) and group discussions (n = 10) were conducted among men and women aged 15-27 years from different ethnic backgrounds recruited from youth and genitourinary medicine clinic settings in Brent, London. The interviews explored the context within which STI-related risks were assessed, experienced and avoided, the skills needed to recognise risk and the barriers to behaviour change. RESULTS: Concurrent sexual partnerships, mismatched perceptions and expectations, and barriers to condom use contributed to STI risk exposure and difficulties in implementing risk-reduction strategies. Women attempted to achieve monogamy, but experienced complex and fluid sexual relationships. Low risk awareness, flawed partner risk assessments, negative perceptions of condoms and lack of control hindered condom use. Whereas men made conscious decisions, women experienced persuasion, deceit and difficulty in requesting condom use, particularly with older partners. CONCLUSIONS: Knowledge of STI and condom use skills is not enough to equip young people with the means to reduce STI risk. Interventions with young women need to place greater emphasis on: entering and maintaining healthy relationships; awareness of risks attached to different forms of concurrency and how concurrency arises; skills to redress power imbalances and building self-esteem.
Assuntos
Preservativos/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Grupos Minoritários , Comportamento Sexual/etnologia , Infecções Sexualmente Transmissíveis/etnologia , Adolescente , Adulto , Fatores Etários , População Negra/etnologia , Região do Caribe/etnologia , Estudos de Viabilidade , Feminino , Humanos , Relações Interpessoais , Entrevistas como Assunto , Londres/epidemiologia , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Comportamento Sexual/psicologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Estados Unidos , Saúde da Mulher/etnologia , Adulto Jovem , Iugoslávia/etnologiaRESUMO
OBJECTIVES: The INSIGHT case-control study confirmed that HIV serodiscordant unprotected anal intercourse (SdUAI) remains the primary risk factor for HIV infection in gay men in England. This paper uses qualitative follow-up data to examine the contexts of SdUAI and other risk factors among the case-control study participants. METHODS: In-depth interviews were conducted with 26 recent HIV seroconverters and 22 non-converters. Purposive selection was used to provide diversity in demographics and sexual behaviour and to facilitate exploration of risk factors identified in the case-control study. RESULTS: Condoms were perceived as barriers to intimacy, trust and spontaneity. The potential consequences of the loss of these were traded off against the consequences of HIV infection. Previous negative HIV tests and the adoption of risk reduction strategies diminished the perceived threat of HIV infection, supporting beliefs that HIV was something that happened to others. Depression and low self-esteem, often combined with use of alcohol or other drugs, led to further risk taking and loss of control over risk reduction strategies. CONCLUSIONS: A range of psychosocial reasons led some men to engage in UAI with serodiscordant or unknown partners, despite high levels of risk awareness. Men in their mid-life, those in serodiscordant relationships and men that had experienced bereavement or other significant, negative, life events revealed factors related to these circumstances that contributed to increases in risky UAI. A diverse portfolio of interventions is required to build confidence and control over safer sex practices that are responsive to gay men's wider emotional needs.
Assuntos
Soropositividade para HIV/psicologia , Homossexualidade Masculina/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Sexo sem Proteção/psicologia , Adulto , Idoso , Atitude Frente a Saúde , Preservativos/estatística & dados numéricos , Inglaterra , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Adulto JovemRESUMO
OBJECTIVES: To detect and quantify current risk factors for HIV seroconversion among gay men seeking repeat tests at sexual health clinics. DESIGN: Unmatched case control study conducted in London, Brighton and Manchester, UK. METHODS: 75 cases (recent HIV positive test following a negative test within the past 2 years) and 157 controls (recent HIV negative test following a previous negative test within the past 2 years) completed a computer-assisted self interview focused on sexual behaviour and lifestyle between HIV tests. RESULTS: Cases and controls were similar in socio-demographics, years since commencing sex with men, lifetime number of HIV tests, reasons for seeking their previous HIV tests and the interval between last HIV tests (mean = 10.5 months). Risk factors between tests included unprotected receptive anal intercourse (URAI) with partners not believed to be HIV negative (adjusted odds ratio (AOR) and 95% confidence interval 4.1, 1.8 to 9.3), where increased risk was associated with concomitant use of nitrite inhalants, receiving ejaculate and increasing numbers of partners. Independent risk was also detected for unprotected insertive anal intercourse (UIAI) with more than one man (AOR 2.7, 1.3 to 5.5) and use of nitrite inhalants (AOR 2.4, 1.1 to 5.2). CONCLUSIONS: HIV serodiscordant unprotected anal intercourse remains the primary context for HIV transmission among gay men, with increased risk associated with being the receptive partner, receiving ejaculate and use of nitrite inhalants. Although the HIV transmission risk of URAI is widely acknowledged, this study highlights the risk of UIAI and that nitrite inhalants may be an important facilitator of transmission when HIV exposure occurs.
Assuntos
Soropositividade para HIV/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Adulto , Idoso , Estudos de Casos e Controles , Inglaterra/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Fatores de Risco , Sexo sem Proteção/estatística & dados numéricosRESUMO
OBJECTIVES: To estimate HIV prevalence and the distribution of high risk sexual behaviours, sexual health service use, and HIV testing among black Africans aged 16 years or over in England. To determine demographic, behavioural and service use factors associated with HIV prevalence. METHODS: A cross-sectional community-based survey (Mayisha II) in London, Luton and the West Midlands. A short (24-item) anonymous self-completion questionnaire with linked voluntary anonymous oral fluid sampling, using an Orasure device for HIV testing. RESULTS: A total of 1359 eligible black African men (51.9%) and women (48.1%) were recruited, of whom 74% (1006) provided a sufficient oral fluid sample for HIV testing. 42.9% of men and 50.9% of women reported ever having had an HIV test. Overall, 14.0% (141, 95% CI 11.9 to 16.3) of respondents tested HIV positive (13.1% of men and 15.0% of women); 9.2% (93) had undiagnosed HIV infection, while 4.8% (48) had a diagnosed HIV infection. HIV prevalence was significantly higher in men: born in East Africa; who had had a previous STI diagnosis; or who were recruited in bars and clubs; and in women: born in East or Southern Africa; aged 25 years and over; who had had two new sexual partners in the past 12 months; or who had had a previous STI diagnosis. CONCLUSIONS: Despite about half the sample having had an HIV test at some time in the past, 9.2% of respondents had an undiagnosed HIV infection. This study supports current policy efforts to further promote HIV testing and serostatus awareness.
Assuntos
Atitude Frente a Saúde , População Negra/estatística & dados numéricos , Infecções por HIV/etnologia , Estilo de Vida , Sexo sem Proteção/estatística & dados numéricos , Adulto , Idoso , População Negra/psicologia , Inglaterra/epidemiologia , Feminino , Infecções por HIV/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Sexo sem Proteção/psicologiaRESUMO
OBJECTIVE: To estimate the incidence of the Jarisch-Herxheimer reaction in pregnant women undergoing treatment of syphilis and the incidence of changes in uterine activity or fetal heart rate (FHR). METHODS: Pregnant women of at least 24 weeks' gestation diagnosed as needing treatment of syphilis were reviewed retrospectively. Patients were admitted for their first dose of benzathine penicillin, and the FHR was recorded continuously before and for 24 hours after injection. The occurrence of the Jarisch-Herxheimer reaction was noted, and all available FHR records for this admission were reviewed. Evaluations for changes in the FHR pattern and uterine activity were made. Statistical comparisons used Student t, Fischer exact, and chi2 tests, when applicable (significance P < .05). RESULTS: We reviewed 50 charts and 31 available FHR records. The average gestational age was 30.8 weeks. We found 20 cases of probable Jarisch-Herxheimer reaction (40%). Thirteen of 31 patients (41.9%) developed regular uterine contractions, median onset, 10 hours. All resolved within 24 hours of treatment. Patients with uterine contractions had a greater mean increase in temperature (1.15F versus 0.68F, P < .008). Twelve of 31 women (38.7%) developed recurrent variable decelerations, median onset, 8 hours. All patients but one had their contractions resolve within 24 hours of treatment. Lower gestational age was associated with the occurrence of recurrent variable decelerations (29.6 weeks versus 32.3 weeks, P < .05). No patients required delivery at the time of treatment. CONCLUSION: The incidence of Jarisch-Herxheimer reaction in treated syphilitic pregnancies is about 40%; similar proportions of patients develop regular uterine contractions and recurrent variable decelerations.
Assuntos
Febre/etiologia , Frequência Cardíaca Fetal/fisiologia , Complicações Infecciosas na Gravidez/tratamento farmacológico , Sífilis/tratamento farmacológico , Contração Uterina/fisiologia , Adulto , Feminino , Monitorização Fetal , Humanos , Penicilina G Benzatina/uso terapêutico , Penicilinas/uso terapêutico , Gravidez , Complicações Infecciosas na Gravidez/fisiopatologia , Estudos Retrospectivos , Estatística como Assunto , Sífilis/fisiopatologiaRESUMO
Although vestibular nystagmus is known to be affected by variations in mental states, little information is available about the effects of drugs on vestibular responses when a) subjects are either alert or relaxed, and b) visual stimuli are available or denied. In this study, 30 men were assigned to d-amphetamine sulphage (10 mg), secobarbital sodium (100 mg), or placebo (no drug) groups. With subjects alert in darkness, the drugs had no differential effect on rotation-induced vestibular nystagmus; when subjects were relaxed there was significantly less nystagmus than in the alert condition, particularly for the seco-barbital group. With vision permitted, d-amphetamine had no statistically different effect on nystagmus from the placebo. However, subjects given secobarbital were unable to use visual fixation effectively to suppress vestibular eye movements and their visual-following ability as measured by optokinetic nystagmus was also suppressed. Control over the mental activity of subjects and assessment of oculomotor-related functions both with and without opportunities for visual fixation are both important in evaluating drug effects.
Assuntos
Anfetamina/farmacologia , Movimentos Oculares/efeitos dos fármacos , Secobarbital/farmacologia , Núcleos Vestibulares/efeitos dos fármacos , Adulto , Medicina Aeroespacial , Pressão Sanguínea , Fixação Ocular/efeitos dos fármacos , Frequência Cardíaca , Humanos , Masculino , Processos Mentais , Músculos Oculomotores/efeitos dos fármacos , Placebos , Rotação , Visão OcularRESUMO
While the basic efficacy of antimotion sickness drugs is rooted in the reduction of motion sickness symptoms, adverse side effects are important practical considerations of their usage in aviation. This study examined the influence of three established antimotion sickness drugs on nystagmic eye movement responses to angular acceleration (whole-body movement) with vision either permitted or denied, and to optokinetic stimulation (visual field movement). Dimenhydrinate and promethazine hydrochloride, particularly at higher dose levels, reduced optokinetic nystagmus, thereby making less accurate the following ability of the eye. During whole-body motion in darkness, there was little placebo-drug difference in the vestibular response under alert conditions; under relaxed conditions, dimenhydrinate and promethazine hydrochloride produced significant declines in the vestibular eye movements. These same drugs also interfered with the ability of the individual to fixate adequately on a visual task during motion. Subjects who received a combination of promethazine plus d-amphetamine were able to suppress vestibular eye movements and maintain good visual fixation under the task condition. Thus, the effect of a drug on nystagmus may be a poor indicator of its value in preventing motion sickness. Moreover, assessments of antimotion sickness drugs for many practical situations should include, as a possible adverse side effect, the inability to maintain visual fixation during motion.
Assuntos
Aceleração , Enjoo devido ao Movimento/tratamento farmacológico , Nistagmo Fisiológico/efeitos dos fármacos , Dextroanfetamina/uso terapêutico , Dimenidrinato/uso terapêutico , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Fixação Ocular/efeitos dos fármacos , Humanos , Cinestesia/efeitos dos fármacos , Masculino , Percepção de Movimento/efeitos dos fármacos , Prometazina/uso terapêuticoRESUMO
Two studies examined the influence of three established antimotion sickness drugs on tracking performance in static (stationary) and dynamic (angular acceleration) conditions and on visual fixation ability during motion. In Study I, 40 young men were randomly assigned in equal numbers to either a control (lactose placebo), dimenhydrinate (50 mg), promethazine hydrochloride (25 mg), or mixture (25 mg promethazine plus 10 mg d-amphetamine) group. Study II used 30 new subjects equally divided into control, dimenhydrinate (100 mg), and promethazine (50 mg) groups. Following practice, tests were conducted prior to, and 1, 2, and 4 h after drug ingestion. The depressant drugs had little effect on static tracking, but impaired dynamic tracking performance and reduced ability to maintain visual fixation on a localizer/glide slope instrument due to increased ocular nystagmus. The mixture of promethazine plus d-amphetamine produced none of these deleterious effects.
Assuntos
Medicina Aeroespacial , Dextroanfetamina/efeitos adversos , Dimenidrinato/efeitos adversos , Enjoo devido ao Movimento/tratamento farmacológico , Prometazina/efeitos adversos , Desempenho Psicomotor/efeitos dos fármacos , Afeto/efeitos dos fármacos , Nível de Alerta/efeitos dos fármacos , Dextroanfetamina/uso terapêutico , Dimenidrinato/uso terapêutico , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Humanos , Nistagmo Fisiológico/efeitos dos fármacos , Orientação/efeitos dos fármacos , Prometazina/uso terapêuticoAssuntos
Controle de Doenças Transmissíveis/normas , Atenção à Saúde/normas , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Vigilância da População , Guias de Prática Clínica como Assunto , Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/prevenção & controle , População Negra/estatística & dados numéricos , Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Feminino , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Incidência , Masculino , Padrões de Prática Médica/normas , Medição de Risco/normas , Fatores de RiscoRESUMO
We compared sociodemographic characteristics, sexual risk behaviours and sexual health experiences of 266 heterosexual black Caribbeans recruited at a London sexual health clinic between September 2005 and January 2006 with 402 heterosexual black Caribbeans interviewed for a British probability survey between May 1999 and August 2001. Male clinic attendees were more likely than men in the national survey to report: ≥10 sexual partners (lifetime; adjusted odds ratio [AOR]: 3.27, 95% confidence interval [CI]: 1.66-6.42), ≥2 partners (last year; AOR: 5.40, 95% CI: 2.64-11.0), concurrent partnerships (AOR: 3.26, 95% CI: 1.61-6.60), sex with partner(s) from the Caribbean (last 5 years; AOR: 7.97, 95% CI: 2.42-26.2) and previous sexually transmitted infection (STI) diagnosis/diagnoses (last 5 years; AOR: 16.2, 95% CI: 8.04-32.6). Similar patterns were observed for women clinic attendees, who also had increased odds of termination of pregnancy (AOR: 3.25, 95% CI: 1.87-5.66). These results highlight the substantially higher levels of several high-risk sexual behaviours among UK black Caribbeans attending a sexual health clinic compared with those in the general population. High-risk individuals are under-represented in probability samples, and it is therefore important that convenience samples of high-risk individuals are performed in conjunction with nationally representative surveys to fully understand the risk behaviours and sexual health-care needs of ethnic minority communities.
Assuntos
População Negra , Heterossexualidade/estatística & dados numéricos , Assunção de Riscos , Infecções Sexualmente Transmissíveis/epidemiologia , Adolescente , Adulto , Região do Caribe/epidemiologia , Feminino , Humanos , Londres/epidemiologia , Masculino , Inquéritos e Questionários , Adulto JovemRESUMO
The pilot aim was to assess the feasibility and acceptability of undertaking anonymous HIV testing using oral fluid samples as part of a community-based survey of sexual attitudes and lifestyles of black African communities in London. The three components of the study were administered in various venues across London: (1) a cross-sectional self-completion anonymous questionnaire survey, (2) an optional oral fluid sample for anonymous HIV testing and (3) a nested in-depth interview study in a sub-set of respondents. A total of 114 black African men and women were recruited. A large number of African countries were represented among respondents from newly-migrant and well-established communities. The response rate to the oral fluid sample was high at 82% and all samples collected were of sufficient quality to be tested for HIV. In-depth interviews with respondents revealed positive views and experiences about participating in the study whilst understanding of the questionnaire was good. We therefore conclude that anonymous HIV testing as part of a community-based survey is feasible and acceptable, whilst a set of recommendations was produced to refine the survey methodology and questionnaire. Participatory research methods are essential for achieving successful community-based surveys among black Africans in Britain.
Assuntos
Atitude Frente a Saúde , Infecções por HIV/psicologia , Comportamento Sexual , Adulto , África/etnologia , Idoso , Estudos Transversais , Coleta de Dados , Infecções por HIV/diagnóstico , Infecções por HIV/etnologia , Humanos , Estilo de Vida , Londres/epidemiologia , Pessoa de Meia-Idade , Motivação , Aceitação pelo Paciente de Cuidados de Saúde , Projetos Piloto , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: To examine the factors that influence respondents' willingness to participate in urinary testing for Chlamydia trachomatis in a general population feasibility survey of sexual attitudes and lifestyles. METHODS: 199 sexually experienced, 18-44 year old participants, recruited as part of a larger (n=901) methodological study of sexual attitudes and lifestyles, were invited to provide a urine sample for chlamydial infection testing using ligase chain reaction (LCR) techniques. Analysis of the survey data and in-depth qualitative interviews were undertaken to explore the factors that influenced participants' decisions to participate. RESULTS: 143/199 (72%) participants agreed to provide a urine sample. The likelihood of providing a urine sample was reduced if other individuals were present in the home at the time of interview (OR 0.42, 95% confidence interval 0.20-0.90, p=0.03). Trust and rapport with the interviewer, understanding the aims of the test, sense of obligation, and perceived importance of the test were identified as additional influencing factors in the in-depth interviews. CONCLUSIONS: Survey respondents' uncertainty or embarrassment at participating in urine testing can be overcome if they are well informed, motivated by the potential health gain, and briefed by trained and confident interviewers.