HIV transmission risks of females and males in paired partner relationships.

As the HIV/AIDS epidemic has evolved, heterosexual behaviors have come to be an increasingly important mode of transmission and rates of infection have increased faster among women generally and minority women in particular. Most of what we known about heterosexual risk taking is based on survey data collected from either women or men. These data have been useful for helping to understand different levels and types of risk taking by women and men. However, they provide little information about the levels of risk taking that exist for paired partners in main partner relationships, the types of risks each partner brings to the relationship and how the contribution of partner risks varies. Using data from the pretest of a pilot project designed to test a behavioral intervention to reduce HIV/AIDS transmission among main sex partners, the authors developed four subscales of sexual risk taking for each partner. The association between subscales within and between genders are examined and the subscales are combined to obtain measures of couple risks. Particular attention is given to the gender contribution of partners to couple risk and the differential contribution of types of risk to total risk. The data suggest that, even though men bring relatively higher risks to their main partner relationship than women, this varies inversely with the level of couple risk.

Adolescents' knowledge and beliefs about pregnancy: the impact of "ENABL".

Finding effective ways to prevent adolescent pregnancy is a concern of public health officials, educators, social workers, parents, and legislators. Numerous programs exist, but there is debate as to whether it is the specific program itself or other factors that are responsible for participants' successful outcomes. Using a quasi-experimental design, this study sought to determine which factors predicted changes in knowledge and beliefs among middle school students (N = 1,450) after exposure to Postponing Sexual Involvement (PSI), the curricular component of Education Now and Babies Later (ENABL), a pregnancy prevention program. It was found that the single most important predictor of improvement in knowledge and beliefs about pregnancy prevention was PSI itself, not background variables. The findings contradict some of the previous studies on factors impacting teenage pregnancy and lend support for the continued examination of ENABL as a promising component of pregnancy prevention efforts.

Relationship dynamics, ethnicity and condom use among low-income women.

CONTEXT: Women's protection against HIV and sexually transmitted diseases (STDs) depends upon their ability to negotiate safer sex. It is important to know how cultural norms and gender roles, which vary by ethnicity, may either constrain or encourage negotiation of condom use. METHODS: Questionnaires were completed by 393 low-income non-Hispanic black, Hispanic and non-Hispanic white women who were sexually active and attending family planning and STD clinics and other public health and social service centers in Miami in 1994 and 1995. Multivariate logit techniques were used to identify ethnic differences in relationship dynamics and to determine couple- and individual-level factors associated with consistent use, occasional use or nonuse of condoms. RESULTS: Black and Hispanic women reported higher levels of consistent condom use (15-17%) than did white women (4%). Nearly all black and white women (90-95%) said that they were extremely or somewhat comfortable talking about condoms with their partner, whereas 76% of Hispanic women did so. A larger proportion of Hispanic women (55%) reported joint contraceptive decision-making than did black women (26%) or white women (31%). Among women who reported that their partner made contraceptive decisions, 28% used condoms consistently or occasionally, compared with 24% among women who made the decision themselves. When the couple made the decision jointly, 41% of them were condom users. Hispanic women scored the lowest on a scale of condom-related self-efficacy, yet also reported the highest levels of confidence in their condom negotiating skills. Multivariate analysis indicated that, compared with white women, black and Hispanic women were more likely to be consistent condom users than nonusers (odds ratios, 10.2 and 18.9, respectively). Women who shared financial decision-making with their partner were almost 80% less likely to be a consistent condom user, and women who did not participate in financial decisions were more than 90% less likely to do so, than were women who made monetary decisions independently. CONCLUSIONS: HIV prevention and intervention programs should emphasize birth control discussion between partners and the development of condom-related self-efficacy and negotiation skills, and these programs also should customize prevention messages according to ethnicity and social context.

Dual-method use among an ethnically diverse group of women at risk of HIV infection.

CONTEXT: Few U.S. women protect themselves against both pregnancy and sexually transmitted diseases (STDs) by using an efficient contraceptive method and a condom. Understanding the factors that influence dual-method use could help improve interventions aimed at encouraging protective behaviors. METHODS: Interviews were conducted with 552 low-income women at risk of HIV who attended public health or economic assistance facilities in Miami in 1994 and 1995. Multinomial logit analyses were used to determine the influence of women's background characteristics, perceived vulnerability to pregnancy and AIDS, and relationship characteristics on the odds of dual-method use. RESULTS: Overall, 20% of the women used dual methods. Women who were not married, who worried about both pregnancy and AIDS, who had ever had an STD, who were confident they could refuse a sexual encounter in the absence of a condom and who made family planning decisions jointly with their partner were the most likely to use dual methods rather than a single method (odds ratios, 2.0-3.5); those who considered the condom only somewhat effective in preventing AIDS or who shared economic decision-making with their partner were the least likely to use dual methods rather than a single method (0.5-0.6). The results were generally similar in analyses examining the odds of dual-method use involving an efficient contraceptive, except that black and Hispanic women were significantly more likely than whites to use condoms in conjunction with efficient contraceptives (3.3-7.1). CONCLUSIONS: Both women's individual characteristics and the context of their sexual relationships influence whether they simultaneously protect themselves from pregnancy and HIV. The involvement of male partners in family planning decision-making and women's control over economic decision-making ensure greater protection against HIV infection.

PIP: Promotion of condom use among women who use efficient contraception is essential to protect them from sexually transmitted diseases (STDs), including HIV, as well as pregnancy. However, fear of negative reactions from a male partner may prohibit dual method use among women who are economically dependent on men. To understand the factors that influence dual method use, interviews were conducted with 522 low-income US women at risk of HIV who attended 21 public health, family planning (FP), and STD clinics or economic assistance centers in Miami, Florida (US), in 1994-95. 54% were concerned about both pregnancy and AIDS; 32% were worried about AIDS only and 5% about pregnancy only. 20% of respondents reported dual method use; overall, 36% of women used condoms (either alone or along with another method). The rate of dual method use was 16% among Whites, 24% among Blacks, and 21% among Hispanics. The likelihood of dual method use was significantly enhanced (odds ratio, 2.0-3.5) among women who were not married, worried about both pregnancy and AIDS, had ever had an STD, were confident they could refuse sex with a man who would not use a condom, and made FP decisions jointly with their partner. Women who regarded condoms as only somewhat effective in preventing HIV infection or who shared economic decision-making with their partner rather than making such decisions alone were least likely to use dual methods. Black and Hispanic women were significantly more likely than White women to use condoms in conjunction with efficient contraception.

Ethnic differences in sexual decisions and sexual behavior.

Previous investigators have reported ethnic differences in the expression of sexual decision making and sexual behaviors in women. In a sample of women of low socioeconomic status between ages 18 and 45, we examined the influence of ethnicity and other variables (age, education, marital status, and comfort in discussing sex) on (i) who makes decisions on the timing and type of sex, (ii) whether a woman engages in vaginal, oral, and anal sex, (iii) the frequencies of each type of sex, and (iv) whether or not a woman has multiple partners. Multivariate analyses showed that, independent of other independent variables, ethnicity had little direct effect on most variables. The notable exception was that ethnicity influenced joint decision making regarding the timing and type of sexual activities for Hispanic but not for African American women. We conclude that ethnicity contributes to differences in sexual behaviors but that other variables are equally important.

Factors associated with use of the female condom.

Black, Hispanic and white women recruited for an HIV prevention intervention were instructed in the use of the female condom and encouraged to try the device. Of the 231 women who completed the intervention, 29% tried the condom over the course of a month; 30% of those who tried it used it during at least half of their sexual encounters. Both ethnicity and age were associated with trying the device: Nearly 40% of black women and 30% of Hispanic women did so, compared with 18% of white women; 37% of those aged 25-34 tried the female condom, compared with 22% of women younger than 25. Trying the device was more likely among women living with a partner, those with a history of sexually transmitted disease infection, women who had had an HIV test, those who did not believe that the method afforded them a greater degree of overall control than did the male condom and those who had no prior knowledge of the device. Among women who used the device during at least half of their sexual encounters, 27% were black and 44% were Hispanic: 38% were younger than 25, and 43% were single. More regular users were about half as likely as less regular users to experience difficulty with insertion and one-eighth as likely to report the device slipping during use; they were more likely than less regular users to report that sex was more pleasurable with the female condom than with the male condom.

PIP: As part of a project to test a behavioral intervention for women at risk of human immunodeficiency virus (HIV), women recruited from sexually transmitted disease clinics, family planning clinics, and state economic service centers in Miami, Florida (US), during 1994-95 were offered free supplies of the female condom. 66 of 231 program participants (29%) tried the female condom; 20 (30%) used it for more than half of their sexual encounters in a 1-month period. Both ethnicity and age were associated with acceptance of female condoms. 40% of Black women, 30% of Hispanic women, and 18% of White women tried the female condom; 37% of those 25-34 years old compared with 22% of women younger than 25 years used the device. Among women who used the female condom for more than half their sexual encounters, 27% were Black and 44% were Hispanic; 38% were under 25 years old and 43% were single. 47% of users had a positive response to the method at first use; after 1 month of use, this rate rose to 75%. 85% of women felt more in control of disease protection for themselves when using the female condom than the male condom. Finally, regular users were about half as likely as irregular users to experience difficulty with condom insertion and more likely to report that sex was more pleasurable with the female condom than the male condom. These findings suggest the female condom could be an important element in HIV prevention campaigns, especially those targeted to Black and Hispanic women, and that method satisfaction increases with regular use.

The association between substance use, condom use and sexual risk among low-income women.

Substance use is frequently assumed to be associated with higher levels of sexual risk-taking and lower levels of condom use. An analysis of 668 black, Hispanic and white low-income women at public health and public assistance facilities in Miami show that 19% engaged in risky sexual behavior over the preceding six months, 24% in substance use and 31% in condom use. Overall, substance users are nearly four and one-half times more likely to take sexual risks than nonusers, but are about half as likely to have relied on condoms. When the probability of condom use is considered in the context of both substance use and sexual risk, substance users who take sexual risks appear just as likely to rely on condoms as are nonusers who take sexual risks and those who do not (odds of 0.43-0.49). However, substance users who do not take sexual risks are much less likely to use condoms (odds of 0.15). This pattern holds among black, Hispanic and white women, and suggests that perceptions of risk and the risks that partners bring to sexual encounters may be more important determinants of condom use than substance use per se.

PIP: 668 Black, White, and Hispanic low-income women at 21 public health, sexually transmitted disease (STD), and family planning clinics or state economic service centers in Miami provided data on their sex behavior, drug and alcohol consumption, and condom use. The data were collected from September 1994 through February 1995. Any participant who reported having had sex with three or more partners in the preceding 6 months, exchanging sex for drugs or money in the preceding 6 months, or having a sex partner who they believe has had sex with men or had injected drugs was classified as a sexual risk-taker. Any woman who had taken any recreational drugs in the past 6 months or had drank alcohol before having sex over the same period was classified as a substance user. 19% of the women engaged in risky sex behavior over the preceding 6 months, 24% in substance use, and 31% in condom use. Overall, the substance users are almost 4.5 times more likely to take sexual risks than nonusers, and about half as likely to have used condoms. Substance users who take sexual risks seem just as likely to use condoms as nonusers who take sexual risks and those who do not. However, substance users who do not take sexual risks are far less likely to use condoms. This pattern holds among Black, White, and Hispanic women, and suggests that perceptions of risk and the risks that partners bring to sexual encounters may be more important determinants of condom use than substance use alone.

The Development and Implementation of a Cognitive-Based Intervention Aimed at Culturally Diverse Women at Risk for HIV/AIDS.

The development and implementation of a culturally and gender sensitive, cognitive behavioral-intervention program aimed at preventing high-risk sexual and drug-use behaviors among culturally diverse women at risk for HIV/AIDS is described. The intervention stressed education, cultural/social barriers to change, and assertiveness/negotiation skill building. Methodological problems and their solutions are presented. The article stresses ways to recruit poor at-risk women, how to reduce attrition using incentives such as providing transportation, having food and child care at the intervention sessions, financial rewards, and a tracking system that includes many friends and family members of the participant. Preliminary findings indicated that the intervention was successful in promoting knowledge about HIV/AIDS. At the end of the six-week intervention protocol, the intervention group compared to the control group showed significant improvements in HIV/AIDS knowledge items dealing with clinical aspects of the disease, transmission knowledge, and partner risk knowledge. Knowledge, along with motivation to reduce risk and negotiation skills are essential in changing behaviors that put one at risk.

Are clinical classifications for laryngeal cancer satisfactory?

All clinical classifications for laryngeal cancer are compromises based on clinical and imaging evaluations, with no concern for important elements such as phenotype, host-tumor relationship, and any concomitant nonneoplastic disease. The various staging systems are critically examined along with a report on the outcome of an international survey on the applicability of the TNM system in relation to laryngeal neoplasms, promoted by The Laryngeal Cancer Association.

Substance use among women at risk for HIV infection.

This article reports results from a survey of culturally diverse women at risk for HIV infection in south Florida. Data concerning their substance use and its association with HIV risk behaviors are presented. Results indicate levels of consumption which exceed expectations based on general estimates of female substance use. Further, substance use was associated with specific behaviors and lifestyles which placed the women at increased risk for HIV infection.

Laryngeal morphology in sudden unexpected death in infants.

One hundred and four larynges removed from infants registered as dying from Sudden Infant Death Syndrome (SIDS) and 20 control larynges from infants of matching ages, were examined histologically. Excessive amounts of subglottic submucosal glandular tissue had reduced the available airway by more than half in 35 per cent of the SIDS larynges within the age group two of four months. In 30 per cent of this group the airway reduction was more than 60 percent. It is suggested that hyperplasia of subglottic mucous glands is one cause of fatal hypoxia in sudden unexpected infant death.

Histologic evaluation of the larynx in sudden infant death syndrome.

Seventy-four larynges removed at death from children who died of sudden infant death syndrome (SIDS) have been studied by serial sectioning in the transverse plane. An increase in subepithelial glandular tissue is seen in many specimens, and the reduction in the available subglottic area has been measured with the Measuremouse Image Intensifying system. This preliminary report confirms that in some of these children with SIDS, particularly around the age of 3 months, there is a potentially lethal reduction in subglottic airway secondary to an increase in mucus-secreting glands, possibly from an associated mild upper respiratory tract infection. Accepting that adequate control infants within this age group who have not had any trauma to the laryngotracheal area are not available, these findings offer a possible explanation for what are always tragic events.

AIDS knowledge and risk behaviors among culturally diverse women.

This article reports results from a survey of women at risk for HIV infection. The sample (n = 620) included black (50.6%), white (28.7%), Hispanic (13.4%), and Haitian (5.0%) adult women from south Florida. Data concerning their AIDS knowledge, prevalence of risk behaviors, and perceived vulnerability are presented. Results indicate differences in certain knowledge areas and risk behaviors by race/ethnicity and a consistent incidence of unprotected sex with their main partners across all racial/ethnic groups.

PIP: Florida has the 3rd highest cumulative number of AIDs cases among states in the US, and 12% in Florida are women, which is 3% higher than the national average. The study describes the AIDs knowledge and sexual behavior of women at high risk of HIV infection in 1989 from Dade and Broward counties in Florida. As part of a 3-year project, it was designed to develop a cross sectional description of women at risk, and to develop and evaluate interventions aimed at perinatal AIDs prevention. 620 nonpregnant women were recruited from county jails and detention centers (59.3%), county health, STD, and family planning clinics (26%), alcohol/drug treatment centers (13.6%), and other (1.1%). The mean age of respondents was 28.9 years. 51% were never married, and 76% had 1-3 children. 45% were unemployed. 21% reported income from prostitution and 17% from illegal activity. 44% had ever engaged in prostitution. 83% had used an illegal substance of which 22% was IV drugs. 8.7% were seropositive. 71% received AIDs, STDs, contraception, and sexuality information from the mass media, and 59% from medical professionals and public health clinics. The limitations were the representatives of the sample, and the validity and reliability of the questionnaire. The results of AIDs knowledge, risk behavior, and vulnerability revealed that the majority were well informed about AIDs and HIV infection, with the exception of Haitians. The findings support treating Haitian women as a special population for AIDs prevention programs. Those 20 and 41 years tended to believe myths about AIDs and casual contact and perceived risk based on the appearance of an individual. 75% were unaware of bleach as a remedy for dirty needles. As a subcultural influence, people need more knowledge about safer drug use. Knowledge did not influence risky behavior. Transmission appears to be from heterosexual contact. A greater prevalence of sexual risk behavior was reported with main partners even though 75% agreed one couldn't trust lovers in reporting STDs. Program focus on prostitutes may have limited impact. Hispanics reported the greatest prevalence of risk behaviors, followed by whites, blacks, and Haitians. Over 40% of Hispanic and Haitian and 20% of black women reported intention to not use a condom with a seropositive partner. Economics and gender role norms are a great influence. There was a general lack of perceived vulnerability. Successful community and society level strategies involve continued education, sociocultural sensitivity, gender role issues, sexual decision making, and economic factors.