Vulnerabilidade de homens jovens e suas necessidades de saúde / Vulnerabilidad de hombres jóvenes y sus necesidades de salud / Vulnerability of young men and their health needs

RESUMO Objetivos Identificar as condutas de saúde dos homens jovens universitários; conhecer a percepção dos homens jovens universitários sobre o cuidar de sua saúde; e descrever as práticas adotadas para a prevenção das infecções sexualmente transmissíveis. Método Estudo descritivo e exploratório, com abordagem qualitativa, desenvolvido com 25 jovens universitários entre 18-29 anos numa universidade pública do Rio de Janeiro. Para análise dos dados, utilizou-se a técnica de análise de conteúdo. Resultados Os homens jovens universitários percebem o cuidar como feminino, desconhecendo suas próprias particularidades, com a percepção de que não adoecem e, com isso, só procuram o serviço de saúde em situações de emergência. Conclusão e Implicações para a prática Existem desafios a serem vencidos na prática da assistência, como a visão de invulnerabilidade desses homens, a ausência na busca pelos serviços de saúde, o despreparo dos serviços de saúde para atender às necessidades desses jovens, com base em estratégias que contemplem, de forma singular e holística, essa população. As brechas identificadas no estudo permitem levantar futuras questões e provocar mudanças de atitudes voltadas a situações do contexto masculino, a fim de reverter vulnerabilidades ainda existentes e, também, as consequências dessas atitudes na saúde desses homens.

RESUMEN Objetivos Identificar las conductas de salud de hombres jóvenes universitarios; conocer la percepción de ellos sobre el cuidado de su salud; y describir las prácticas adoptadas para la prevención de las infecciones de transmisión sexual. Método Estudio descriptivo y exploratorio, de enfoque cualitativo, desarrollado con 25 universitarios entre 18-29 años en una universidad pública en Rio de Janeiro. Se utilizó la técnica de análisis de contenido. Resultados Los jóvenes perciben el cuidado como algo femenino, sin darse cuenta de sus propias peculiaridades, con la percepción de que no se enferman y, con esto, solo buscan el servicio de salud en situaciones de emergencia. Conclusión e Implicaciones para la práctica Hay desafíos que superar en la práctica de la atención, como la visión de la invulnerabilidad masculina, la ausencia en la búsqueda de servicios de salud, servicios de salud no preparados para satisfacer las necesidades de estos jóvenes a través de estrategias que contemplan de manera única y holística esa población. Las lagunas identificadas nos permiten plantear preguntas futuras y provocar cambios en las actitudes relacionadas con situaciones del contexto masculino, a fin de revertir las vulnerabilidades existentes y también las consecuencias de estas actitudes en la salud de estos hombres.

ABSTRACT Objectives To identify the health behaviors of university students, young men, to know the perception of them about caring for their health, and to describe practices adopted for the prevention of sexually transmitted infections. Method Descriptive and exploratory study, with a qualitative approach, developed with 25 students aged 18-29 at a public university in Rio de Janeiro. To the data analyzed, the content analysis technique was applied. Results Those university students perceived caring as a female practice. They were unaware of their health peculiarities, with the perception that they do not get sick. Because of that, they only seek health services in emergency health conditions. Conclusion and Implications for practice There are challenges to overcome in the practice of men's care. As the vision of the invulnerability of these men, there is an absence in the search for health services.Furthermore, a sort of unprepared health services does not meet the needs of these young people through strategies that contemplate them uniquely and holistically. The gaps identified allow us to raise inevitable questions and bring about changes in attitudes toward situations in the male context. It is necessary to reverse existing vulnerabilities and consequences on the men's health of these men.

Sexually Transmitted Infection Testing of HIV-Positive Medicare and Medicaid Enrollees Falls Short of Guidelines.

BACKGROUND: Men who have sex with men with HIV have high sexually transmitted infection (STI) incidence. Thus, the Centers for Disease Control and Prevention (CDC) recommends at least yearly STI screening of HIV-infected individuals. METHODS: We calculated testing rates for syphilis, chlamydia, and gonorrhea among HIV-positive Californians with Medicare or Medicaid insurance in 2010. Logistic regressions estimated how testing for each bacterial STI relates to demographic and provider factors. RESULTS: Fewer than two-thirds of HIV-positive Medicare and fewer than three-quarters of Medicaid enrollees received a syphilis test in 2010. Screenings for chlamydia or gonorrhea were less frequent: approximately 30% of Medicare enrollees were tested for chlamydia or gonorrhea in 2010, but higher proportions of Medicaid enrollees were tested (45%-46%). Only 34% of HIV-positive Medicare enrollees who were tested for syphilis were also screened for chlamydia or gonorrhea on the same day. Nearly half of Medicaid enrollees were tested for all 3 STIs on the same day. Patients whose providers had more HIV experience had higher STI testing rates. CONCLUSIONS: Testing rates for chlamydia and gonorrhea infection are low, despite the increase in these infections among people living with HIV and their close association with HIV transmission. Interventions to increase STI testing include the following: prompts in the medical record to routinely conduct syphilis testing on blood drawn for viral load monitoring, opt-out consent for STI testing, and provider education about the clinical importance of STIs among HIV-positive patients. Last, it is crucial to change financial incentives that discourage nucleic acid amplification testing for rectal chlamydia and gonorrhea infections.

Male circumcision: a globally relevant but under-utilized method for the prevention of HIV and other sexually transmitted infections.

Randomized trials have demonstrated that male circumcision (MC) reduces heterosexual acquisition of HIV, herpes simplex virus type 2, human papillomavirus (HPV), and genital ulcer disease among men, and it reduces HPV, genital ulcer disease, bacterial vaginosis, and trichomoniasis among female partners. The pathophysiology behind these effects is multifactorial, relying on anatomic and cellular changes. MC is cost effective and potentially cost saving in both the United States and Africa. The World Health Organization and Joint United Nations Program on HIV/AIDS proposed reaching 80% MC coverage in HIV endemic countries, but current rates fall far behind targets. Barriers to scale-up include supply-side and demand-side challenges. In the United States, neonatal MC rates are decreasing, but the American Academy of Pediatrics now recognizes the medical benefits of MC and supports insurance coverage. Although MC is a globally valuable tool to prevent HIV and other sexually transmitted infections, it is underutilized. Further research is needed to address barriers to MC uptake.

HIV screening in commercially insured patients screened or diagnosed with sexually transmitted diseases or blood-borne pathogens.

BACKGROUND: The Centers for Disease Control strongly recommends HIV screening for all patients who present to health care settings with sexually transmitted diseases (STD) or blood-borne pathogens exposure. The objective of this study is to assess the rates and determinants of HIV screening in a national sample of commercially insured patients screened or diagnosed with an STD or hepatitis B or C. METHODS: We used Poisson regression model with a robust error variance to assess the determinants of HIV screening using administrative claims data from health plans across 6 states (n = 270,423). RESULTS: The overall HIV screening rate of patients who were diagnosed or screened for STDs or hepatitis was low (32.7%); rates were lowest for patients presenting with epididymitis or granuloma inguinale (<10%). Patients aged 25 to 34 years were more likely to be screened than other age groups. Females were significantly less likely to be screened for HIV (prevalence ratio = 0.90; 95% CI = 0.89, 0.91) than males. Patients living in states where no written HIV informed consent was required were significantly more likely to be screened than those living in states where written HIV informed consent was specifically required. CONCLUSIONS: HIV screening rates were low and varied by STD categories. Females and younger and older patients were at increased risk of no HIV screening. Requiring specific written informed consent for HIV screening resulted in less HIV screening. Interventions are urgently needed to increase the HIV screening rate among this at-risk population.

Pavio Erótico: uma experiência de Suzano na prevenção das DST/HIV/Aids e fomento da arte erótica / Pavio Erótico: an experience in the prevention of STD/HIV/Aids and incentive to erotic art in the City of Suzano

Em 2006, as Secretarias de Cultura e de Saúde de Suzano estabeleceram uma parceria para implantar o projeto Pavio Erótico, que consiste em um sarau temático,com a exibição de filmes, declamação de poesias, mesas de diálogo, interpretação de contos, apresentação teatral, dança, música, além da disponibilização de preservativos e materiais informativos, que fomentam as discussões do universo da sexualidade humana à luz das práticas sexuais seguras. O evento tem edições trimestrais, com divulgação por meio de folders, cartazes, agenda cultural, convites e no site da Prefeitura do município. Seu público-alvo são escritores, poetas, artistas, professores e a comunidade em geral. Dentre os resultados alcançados com o projeto estão o incentivo à leitura e à arte erótica; divulgação dos serviços de saúde possibilitando a ampliação e o acesso a exames, orientações, distribuição de preservativos, além da realização do I Concurso de Literatura Erótica de Suzano. Essa proposta inovadora expressa a concepção de saúde não focada na doença e promove o desenvolvimento da cultura na cidade de Suzano.

In 2006, the Health and Culture Departments of the city of Suzano (state of São Paulo) established a partnership to implement the project Pavio Erótico, which is an Erotic Soirée that promotes films exhibitions, poems recitations, dialogs between the participants, literature interpretations, theater, dance, music, besides the distribution of contraceptives and folders. The material stimulates the discussion of human sexuality in light of safe sexual practices. It is a quarterly event and the target audience is composed of writers, poets, artists, teachers and the community in general. Some of the results obtained with the project are: incentive to reading and to erotic art; dissemination of the health services, enabling the expansion and the access to examinations, instructions and contraceptives; and the organization of the 1st Erotic Literature Contest of Suzano. This innovative proposal promotes the development of culture in the city and expresses the health conception in which the focal point is not the disease.

STD, HIV/AIDS, and hepatitis services in Illinois County Jails.

OBJECTIVE: : To assess the availability of STD, HIV/AIDS, and hepatitis services provided at Illinois adult county jails. GOAL: : Identify opportunities and barriers to service provision. STUDY DESIGN: : Telephone survey to those providing medical services in Illinois county jails. RESULTS: : Eighty-one (89%) of 91 Illinois jails responded. Half (49.3%) of the facilities offered on-site testing for STD, HIV/AIDS, and hepatitis on demand/with symptoms, although only 4 offered routine screening. Discharge planning services were offered in only 40% of facilities. Cost (43.2%) and limited staff (14.8%) were cited as primary barriers to service provision. CONCLUSIONS: : Screening, treatment, and discharge planning services for STD, HIV/AIDS, and hepatitis are not universal in Illinois jails. Despite current levels of funding and staffing assistance from health departments to jails, further collaboration is needed to improve case identification and treatment in this high-risk population. Needs assessments are useful in identifying opportunities and barriers to service provision.

Condoms for sexually transmissible infection prevention: politics versus science.

The present review assesses the protection that condoms offer against sexually transmissible infections (STI) and the impact that social, political and religious opinion in the USA has had in the past 8 years on promoting condoms for safer sex. Condoms offer protection against most STI. However, the degree of protection depends on correct and consistent use, the type of sexual activity and the biological characteristics of different infections. Cross-sectional and case-control studies and other observational data provide the majority of evidence for STI prevention. Condoms provide a high level of protection against those infections that are transmitted mainly via infected secretions, including HIV, gonorrhoea, chlamydia and trichomoniasis. Protection against those infections transmitted via skin and mucous membrane contact, including Herpes simplex virus infection and human papilloma virus, appears to be less. The Bush administration, driven by conservative political, social and religious elements in the USA, has mounted a concerted campaign to undermine the role of the condom in health-promotion activities in the USA and overseas by undervaluing and misrepresenting scientific data, and through a sustained and well-funded promotion of abstinence-only education. However, this has lead to considerable controversy and disillusionment with abstinence-only education, both at home and abroad, and there is now incontrovertible evidence that abstinence-only programs are ineffectual.

[The Dutch Health Council report on screening for Chlamydia: too reserved]. / Gezondheidsraadadvies 'Screenen op chlamydia' te terughoudend.

The prevalence of sexually transmitted diseases (STDs) increased in the Netherlands in the years 2000-2003. A recent population-based study showed that Chlamydia infections were a problem in urbanised areas; prevalence in rural areas was low. In 2004, the Dutch Health Council advised against a national screening programme for Chlamydia. However, the newest figures on the distribution of Chlamydia infections suggest that screening in large cities might be cost-effective. Much can be learned from the screening programme in the United Kingdom.

Physicians' opinions on partner management for nonviral sexually transmitted infections.

BACKGROUND: Patient-delivered therapy (PDT) for nonviral sexually transmitted infections (STIs) is the practice of dispensing or prescribing medication to patients for their sex partners. While this practice is effective in preventing re-infection in patients, its use is not widespread. The purpose of this survey was to assess physicians' PDT practices and opinions toward potential benefits and perceived barriers associated with PDT. METHODS: During 2003 and 2004, a random sample of family and general practitioners, internists, emergency medicine physicians, and obstetricians/gynecologists in Connecticut and Rhode Island were mailed surveys and responses were analyzed. RESULTS: A response rate of 53% was obtained. Approximately 50% of 111 respondents reported having ever used PDT, although a much smaller proportion (6%) reported using it frequently. Potential benefits cited by many physicians included preventing the spread of STI (83%), reinforcing need for partner treatment (78%), and prevention of re-infection in the patient (63%). However, many perceived barriers were also noted, including difficulty ensuring delivery of medication to the partner (96%), concern about adverse reactions in partners (88%), liability (75%), and missed opportunities for other clinical services (68%). Half of all respondents said that they would support legislation to authorize PDT. CONCLUSIONS: The use of PDT is not widespread; physicians recognize the benefits of PDT but many concerns were also noted. A growing body of research indicates that several perceived barriers may be largely unsubstantiated. Therefore, dispelling physician concerns and defining the legal environment surrounding PDT might encourage physicians to use PDT when it is clinically indicated, thereby preventing re-infection in patients and further spread in the community.

The effect of HIV, behavioural change, and STD syndromic management on STD epidemiology in sub-Saharan Africa: simulations of Uganda.

An assessment was made of how the HIV epidemic may have influenced sexually transmitted disease (STD) epidemiology in Uganda, and how HIV would affect the effectiveness of syndromic STD treatment programmes during different stages of the epidemic. The dynamic transmission model STDSIM was used to simulate the spread of HIV and four bacterial and one viral STD. Model parameters were quantified using demographic, behavioural, and epidemiological data from rural Rakai and other Ugandan populations. The findings suggest that severe HIV epidemics can markedly alter STD epidemiology, especially if accompanied by a behavioural response. Likely declines in bacterial causes of genital ulcers should be considered in defining policies on syndromic STD management in severe HIV epidemics.

Pelvic inflammatory disease. From diagnosis to prevention.

Pelvic inflammatory disease (PID) refers to infection of the uterus, fallopian tubes, and adjacent pelvic structures that is not associated with surgery or pregnancy. PID causes major medical, social, and economic problems worldwide. Long-term sequelae, most notably tubal factor infertility and ectopic pregnancy, are common and extremely costly to the healthcare system. The most important causative micro-organisms are Chlamydia trachomatis, Neisseria gonorrhoeae, and micro-organisms associated with bacterial vaginosis. The clinical spectrum of PID ranges from subclinical endometritis to severe salpingitis, pyosalpinx, tubo-ovarian abscess, pelvic peritonitis, and perihepatitis. Clinical diagnosis of PID has limitations. The clinical diagnostic criteria are insensitive and nonspecific, and false-positive and false-negative diagnosis is common; however, direct visual diagnosis is not always feasible, requires general anesthesia, and is costly. More research is needed of noninvasive diagnosis of PID. Current treatment guidelines call for broad-spectrum antimicrobial coverage. Screening for asymptomatic chlamydial infection is the mainstay of prevention of PID. Emerging evidence from randomized controlled trials provides strong evidence that intervention with selective screening for chlamydial infection effectively reduces the incidence of PID.