Married men's sexual and reproductive health concerns and related health-seeking behavior in Bangladesh: A mixed methods study.

BACKGROUND: In Bangladesh, men's sexual and reproductive health (SRH) needs and related services are often neglected. Little is known of men's SRH concerns, and of the phenomenal growth of the informal and private health actors in the provision of sexual health services to men in rural and urban areas of Bangladesh. METHODS: Using a mixed methods approach, a survey of 311 married men in three rural and urban sites was conducted in three different districts of Bangladesh and 60 in-depth interviews were conducted to understand their SRH concerns and choice of providers to seek treatment. RESULTS: The research findings reveal that- men's various SRH concerns are embedded in psychosocial and cultural concerns about their masculinity and expectations of themselves as sexual beings, with worries about performance, loss of semen and virility being dominant concerns. Sexually transmitted infections (STIs) were also mentioned as a concern but ranked much lower. Informal providers such as village doctors (rural medical practitioners and palli chikitsoks), drug store salespeople, homeopaths, traditional healers (Ojha/pir/fakir, kabiraj, totka) and street sellers of medicines are popular, accessible and dominate the supply chain. CONCLUSION: There is a need of appropriate interventions to address men's anxieties and worries about their sexual abilities, well-being and choice of providers. This would go a long way to address and alleviate concerns, as well as identify and push men to seek  formal care for asymptomatic STIs, and thereby reduce costs incurred and gender tensions in households.

Militância enquanto convite ao diálogo: o caso da militância monodissidente / Activism as an invitation for the dialogue: the case of monodissident activism / La militancia como invitación al diálogo: el caso de la militancia monodisidente

Este artigo é uma produção teórica de caráter reflexivo que focaliza a relação entre pesquisa e militância a partir do construtivismo semiótico-cultural em psicologia, tendo como base o caso da militância monodissidente. A noção de monodissidência foi cunhada no percurso da militância bissexual para se referir a uma ferramenta analítica de ordem político-comunitária que contempla todas as pessoas que se atraem sexual e/ou romanticamente por mais de um gênero. São contrapostas concepções distintas de militância político-social em psicologia: de um lado, militância é entendida a partir de um autocentramento do militante, vinculado a uma rede de exclusões, negações, vedação e defesas psicológicas em relação à experiência; de outro, há uma compreensão dialógica de militância. Metodologicamente, a proposta de pesquisa se fundamenta no campo da participação observante, entendendo que o pesquisador está, primeiro, na condição de participante de certo campo sociocultural, a partir do qual passa a observar e refletir sobre fenômenos que ocorrem nele. Tomamos como ilustração a trajetória de construção da militância monodissidente do primeiro autor, trazendo tensionamentos dialógicos para a análise, postos em discussão com outras reflexões situadas sobre o tema. O conjunto de tensionamentos dialógicos emergidos nesse percurso foi mapeado e compreendido como um processo de multiplicação dialógica no encontro de self pesquisador com o self militante.(AU)

This paper is a theoretical production of reflective character that focuses on the relationship between research and activism from the semiotic-cultural constructivism in psychology, based on the case of monodissident activism. The notion of monodissent was coined during bisexual activism to refer to an analytical tool of a political-community order that includes all people who are sexually and/or romantically attracted to more than one gender. Different conceptions of political-social activism in psychology are opposed: on the one hand, activism is understood from the militant's self-centeredness, linked to a network of exclusions, denials, gatekeeping, and psychological defenses regarding experience; on the other hand, there is a dialogical understanding of activism. Methodologically, the research proposal is based on the field of observant participation, understanding that the researcher is, first, in the condition of a participant in a certain sociocultural field, from which he starts to observe and reflect on phenomena that occur there. We take as an illustration the trajectory of the construction of the monodissident activism of the first author, bringing dialogical tensions to the analysis, discussed with other reflections on the subject. The set of dialogic tensions that emerged in this path was mapped and understood as a process of dialogic multiplication in the encounter of the researcher self with the activist self.(AU)

Este artículo realiza una producción teórica y reflexiva sobre la relación entre investigación y activismo desde el constructivismo semiótico-cultural en Psicología, a partir del caso del activismo monodisidente. La noción de monodisidencia fue acuñada en el transcurso de la militancia bisexual para referirse a una herramienta analítica de orden político-comunitario que incluye a todas las personas que se sienten atraídas sexual y / o románticamente por más de un género. Se contraponen distintas concepciones de la militancia político-social en Psicología: por un lado, la militancia se entiende desde el egocentrismo del militante, vinculado a un entramado de exclusiones, negaciones, sellamientos y defensas psicológicas con relación a la experiencia; por otro, existe una comprensión dialógica de la militancia. La investigación utiliza como metodología la participación del observador, entendiendo que el investigador se encuentra, en primer lugar, en la condición de participante de determinado campo sociocultural, desde donde comienza a observar y reflexionar sobre los fenómenos que allí ocurren. Tomamos como ilustración la trayectoria de la construcción de la militancia monodisidente del primer autor, trayendo tensiones dialógicas al análisis, discutidas con otras reflexiones sobre el tema. El conjunto de tensiones dialógicas que surgieron en este camino se caracteriza y se comprende como un proceso de multiplicación dialógica en el encuentro del self investigador con el self militante.(AU)

Internet treatment of sexually transmitted infections - a public health hazard?

BACKGROUND: Owing to the stigma associated with sexually transmitted infections, patients may prefer to keep their illness private, and choose instead to try self-treatment remedies from the internet. However, such remedies may prove hazardous if the sellers do not provide detailed advice on adverse effects, or on avoiding transmission and re-infection. We conducted an internet search to determine the availability of treatments for STIs and the nature of information provided by vendors of these treatments. METHODS: We conducted a systematic internet search using five different search engines in February 2007. The search term included the words "self treatment" and the name of six different common STIs. We visited the vendors' websites and recorded any information on the formulation, adverse effects, cautions, and prevention of infection. RESULTS: We identified a total of 77 treatments from 52 different companies, most of which were sold from the UK and US. The available remedies were predominantly for topical use and consisted mainly of homeopathic remedies. Only a small proportion of the web-listed products gave details on adverse effects, contraindications and interactions (22%, 25% and 9% respectively). Similarly, web vendors seldom provided advice on treatment of sexual contacts (20% of chlamydia and 25% of gonorrhea treatments) or on preventive measures (13%). Conversely, evidence of effectiveness was claimed for approximately 50% of the products. CONCLUSION: While treatments for certain STIs are widely available on the internet, purchasers of such products may potentially suffer harm because of the lack of information on adverse effects, interactions and contra-indications. Moreover, we consider the paucity of preventive health advice to be a serious omission, thereby leading to patients being needlessly exposed to, and potentially re-infected with the causative pathogens.

Chinese vegetative materia medica in a venereological treatise by Jean Astruc from 1740.

ETHNOPHARMACOLOGICAL RELEVANCE: Historical medical sources can be still queried for forgotten cures and remedies. Traditional Chinese medicine has dealt with lues venerea (syphilis) since the Five Dynasties period (10th century). Chinese indigenous materia medica and remedies recorded, studied or imported by the Europeans can reveal known or quite unknown medicinal plants. The studied Jean Astruc's work is a published ethnopharmacological survey carried out in Beijing in the 1730s and it deserves a modern interpretation. AIM OF THE STUDY: This is the first proposal to identify historical Chinese medicinal plants listed in a scarcely known medical treatise De Morbis venereis… ('On venereal diseases…') by Jean Astruc from 1740. I searched for the current uses and position of the taxonomically identified herbal stock in both traditional Chinese and official medical knowledge, with special attention to syphilis. MATERIAL AND METHODS: Chinese names of drugs and their botanical identities (originally expressed by means of pre-Linnaean polynomials, and now interpreted as accepted binomials) were independently cross-checked with younger till most recent taxonomical and ethnopharmacological sources. Plants and drugs identified this way were queried for their modern applications in traditional Chinese and official medicine with special attention to sexually transmitted diseases (STD) and other uses which are similar to the 18th-century understanding of venereology. RESULTS: For 24 items of medicinal stock, 34 medicinal plants have been identified or suspected: Acacia catechu, Achyranthes bidentata, Akebia quinata, Angelica dahurica, A. sinensis, Aquilaria sinensis, Aralia cordata, Aristolochia fangchi, Chaenomeles sinensis, Ch. speciosa, Clematis vitalba, Coix lacryma-jobi, Commiphora myrrha, Cydonia oblonga, Daemonorops draco, D. jenkinsiana, Dictamnus dasycarpus, Dryobalanops sumatrensis, Forsythia suspensa, Glycyrrhiza uralensis, Lonicera confusa, L. hypoglauca, L. japonica, Ligusticum striatum (=L. chuanxiong), Piper kadsura, Pterocarpus officinalis, Saposhnikovia divaricata, Sassafras tzumu, Smilax china, S. glabra, Stephania tetrandra, Styphnolobium japonicum, Trichosanthes japonica, T. kirilowii; China wax is also mentioned. Out of them, only Lonicera japonica is being used in China in late syphilis, Achyranthes bidentata in gonorrhoea, and Dictamnus dasycarpus in gynaecological problems. In the Astruc's study, 3 medicinal plant species and 5 further plant genera are correctly determined; other plant parts were misidentified. CONCLUSIONS: Antisyphilitic actions ascribed to the Chinese medical formulas and their constituents studied by Astruc, seem to have come from Hg or As compounds rather than from vegetative materia medica. The formulas contained only one species still known in TCM as a remedy for syphilis.

Herbal medicines for sexually transmitted diseases and AIDS.

Sexually transmitted diseases (STDs) and acquired immunodeficiency syndrome (AIDS) are gaining significant importance at present due to rapid spread of the diseases, high cost of treatment, and the increased risk of transmission of other STDs and AIDS. Current therapies available for symptomatic treatment of STDs and AIDS are quite expensive beyond the reach of common man and are associated with emergence of drug resistance. Many patients of STDs and AIDS are seeking help from alternative systems of medicines such as Unani, Chinese, Ayurvedic, naturopathy, and homeopathy. Since a long time, medicinal plants have been used for the treatment of many infectious diseases without any scientific evidence. At present there is more emphasis on determining the scientific evidence and rationalization of the use of these preparations. Research is in progress to identify plants and their active principles possessing activity against sexually transmitted pathogens including human immunodeficiency virus (HIV) with an objective of providing an effective approach for prevention of transmission and treatment of these diseases. In the present review, plants reported to possess activity or used in traditional systems of medicine for prevention and treatment of STDs including AIDS, herbal formulations for vaginal application, and topical microbicides from herbal origin, have been discussed.

Effects of a health care provider intervention in reduction of sexual risk and related outcomes in economically marginal communities in Mumbai, India.

BACKGROUND: The present study assessed the effectiveness of a brief narrative intervention implemented by trained biomedical and Ayurveda, Yoga, Unani, Siddha, Homeopathy (AYUSH) providers from three low-income communities in Mumbai, India. METHODS: A quasi-experimental research design compared attitudinal and behavioural changes among a cohort of 554 patients presenting gupt rog ('secret sexual illnesses') to biomedical and AYUSH providers who were trained in the narrative intervention model (NIM; referred to as 'narrative prevention counseling' in the intervention manual) with those providing standard care (untrained in NIM). Data were analysed using multivariate and longitudinal statistical models. RESULTS: Patients who received treatment for gupt rog from trained providers reported receiving a significantly higher number of services than those receiving services from untrained providers (mean 8.9 vs 7.6 services, respectively; P<0.001). In addition, a higher number of patients seeing the trained providers no longer had gupt rog problems than those seeing untrained providers (42% vs 25%, respectively; P<0.001). Patient-reported sex with a partner who was not the wife decreased significantly from baseline to follow-up for the entire sample but was significantly greater among patients receiving treatment from trained AYUSH providers (from 27% at baseline to 2% at follow up) compared with untrained providers (from 18% at baseline to 5% at follow up; P<0.001). CONCLUSIONS: The results support the effectiveness of brief narrative intervention in primary care settings for reducing sexual risk and associated vulnerabilities among married men.

Formal and informal sector health providers in southern India: role in the prevention and care of sexually transmitted infections, including HIV/AIDS.

Healthcare providers (HCPs) play a central role in the provision of prevention and care services for people with sexually transmitted infections (STIs), including HIV/AIDS. However, the degree of readiness for this role through appropriate training and experience is not clear. In the case of both the urban and rural areas of the state of Karnataka, India, primary and secondary healthcare is provided by practitioners who can be categorised into three major groups: qualified allopathic physicians, qualified non-allopathic doctors (homeopathic and Ayurvedic) and registered medical practitioners. In 2002, the India-Canada Collaborative HIV/AIDS Project conducted a study in an urban area and a rural district of the state of Karnataka, collecting information from 998 care providers regarding attitudes, knowledge and practices related to STI care and HIV/AIDS care in particular. This paper analyses and compares the three different types of HCPs with respect to these parameters and discusses implications for STI/HIV/AIDS prevention and care programs.

Doenças sexualmente transmissíveis na mulher: como abordar? / Sexually transmitted diseases in women: how to broach them?

O presente estudo visou realizar uma revisão sistemática da literatura em relação à abordagem das mulheres com doenças sexualmente transmissíveis (DST). As síndromes clínicas abordadas abrangeram uretrites, cervicites, corrimento vaginal e úlceras genitais. A propedêutica indicada incluiu exames diretos e bioquímicos, métodos sorológicos, microbiológicos e de biologia molecular. O tratamento foi recomendado de acordo com o diagnóstico sindrômico ou etiológico, de acordo com a disponibilidade de exames complementares. Além disso, incluiu-se também a abordagem de parceiros, gestantes e mulheres coinfectadas pelo HIV.

This paper presents a systematic literature review on the management of women with sexually transmitted diseases (STD). The clinical syndromes discussed were urethritis and cervicitis, vaginal discharge and genital ulcers. Complementary studies included direct examination and biochemical reactions, serology, microbiological and molecular biology methods. The treatment was recommended in accordance with syndromic or etiologic diagnosis and with the availability of complementary examinations. Moreover, the approach towards partners, pregnant women and HIV co-infected women was also included.

J'ai vu une femme publique'. Sexuality, venereal disease and homoeopathy in nineteenth-century Ghent: the tale of the patient.

Using the casebooks of the Ghent homoeopathic physician Gustave van den Berghe (born Zwevegem, 1836; died Ghent, 1902), this essay reconstructs patients' experience with sexuality and venereal disease during the late 19th century. Van den Berghe's records are uncharacteristic in that they do not translate the patient's descriptions into medical terms. The casebooks therefore represent an opportunity to hear about the disease and its social context in the patient's own words. Reading these case reports carefully, we can begin to understand not only what it meant to suffer from venereal disease, but also what motivated people to seek homoeopathy in general and this healer in particular.

Les maladies sexuellement transmissibles / The sexually transmitted deseases

Le panorama des Maladies Sexuellement Transmissibles (MST) a bien change au fil des deux dernieres decennies. A cote des affections classiques et bien connues comme la syphilis et la blennorragie est venu... (AU)

Les troubles de la sexualité féminine / Troubles of female sexuality

Ce vaste sujet peut être considéré selon deux pôles: les troubles génitaux locaux ou loco-régionaux, infectieux ou autres, perturbant par leur intensité la sexualité, où l'homéopathie a l'avantage d'éviter les traitements lourds et leurs effets secondaires, et de pouvoir... (AU)

Hahnemann et les maladies sexuellement transmissibles / Hahnemann and sexually transmitted deseases

L'objectif de ce travail etait de rassembler les ecrits d'Hahnemann concernant les maladies sexuellement transmissibles. J'ai utilise ses differentes publications et une partie de ses livres de... (AU)