Peter the Great and sexually transmitted diseases.

Shortly after syphilis appeared in Europe at the time of Columbus' voyage to the New World, the big pox, as it was often known, became a serious issue in Russia for diagnosis, treatment, and prevention. Members of the Russian royal family were made aware of the disease from adolescence onward. Czar Peter the Great had many sexual contacts and could have contracted any number of sexually transmitted diseases (STDs) that were quite common in his era. Nevertheless, contributions analyzed from available sources by his contemporary doctors, and later from medical analyses, reveal no evidence that he had contracted syphilis or any other STD. Most likely, he died from acute renal failure due to urinary tract obstruction.

Strategies to facilitate safe sexual practices in adolescents through integrated health systems in selected districts of Zimbabwe: a mixed method study protocol.

BACKGROUND: Zimbabwe has the highest teenage pregnancy rate in Sub Saharan Africa. Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) prevalence in adolescents that are from tribes that perform cultural initiations and subscribe to certain norms are higher than the national prevalence which is estimated at 12% (18 and 13.6% respectively) in Zimbabwe. Indigenous Health Systems (IHSs) and Modern Health Systems (MHSs) in Zimbabwe run parallel thereby introducing challenges in the management of adolescent sexual health due to conflicts. This study seeks to develop strategies that will facilitate the integration of IHSs and MHS in Mberengwa and Umguza districts. METHODS: This research will be conducted in two phases. The first phase would utilise a concurrent triangulation mixed methods design with both qualitative and quantitative approaches. The findings from the qualitative and quantitative approaches would be merged through a comparison of findings side by side. The second phase would focus on the development and validation of strategies that would facilitate the integration of IHSs and MHSs. The Strength, Weakness, Opportunity and Threat (SWOT) analysis would be applied on interfaced findings from phase one. The Basic Logic and the Build, Overcome, Explore and Minimise (BOEM) models would then be used to develop strategies based on the SWOT findings. The developed strategies would be validated through the application of Delphi technique and administration of checklist to selected key stakeholders through organised workshops. DISCUSSION: There have been no known studies found in the literature that explores the possibility and developed strategies of integrating IHSs and MHSs so as to promote safe sexual practices in adolescents. Most programs on sexual health have ignored the role of IHSs and MHSs in influencing safe sexual practices leading to them failing to attain desired goals. A lot of emphases has been targeted at minimising the spread of Sexually Transmitted Infections (STIs) through advocating for utilisation MHSs rather than focussing on an integrating systems that are meant to manage Adolescent Sexual Health (ASH) related issues. The study protocol was approved by the University of Venda Ethics Committee Registration (SHS/19/PH/17/2608) on the 26th of August 2019.

Trabajadores sexuales masculinos: entre el sexo seguro y el riesgo. Etnografía en una sauna gay de Barcelona, España / Male sex workers: between safe sex and risk. Ethnography in a gay sauna in Barcelona, Spain

Resumen Esta etnografía se realizó en Barcelona, ciudad que ofrece diferentes recursos de ocio homosexual, como las saunas gay. El objetivo fue analizar desde los estudios sobre género y masculinidades, cómo se articula la sexualidad, la percepción sobre la infección por VIH y otras infecciones de transmisión sexual (ITS), y las medidas preventivas en trabajadores sexuales masculinos (TSM) usuarios de saunas gay. Se realizaron 10 entrevistas en profundidad y observación entre 2012 y 2016. Las prácticas de sexo seguro son más frecuentes con clientes, mientras que las de riesgo se realizan más con parejas no comerciales. La orientación sexual juega un rol relevante, los homosexuales asumen más prácticas de riesgo en el trabajo sexual que los heterosexuales. Consumo de drogas o la escasez de redes de apoyo se relacionaron con mayor vulnerabilidad social y conductas de riesgo. Contraer el VIH aún genera miedo, mientras que tener otras ITS se percibe como parte de la vida sexual de un hombre. El TSM afianza una masculinidad con múltiples parejas sexuales, breadwinner y por otra parte, cuestiona un modelo heteronormativo. Las intervenciones para la prevención del VIH e ITS en este colectivo, deberían considerar los determinantes sociales como las precarias alternativas laborales y el ofrecer mayor soporte social.

Abstract This ethnography was conducted in Barcelona, a city that provides different gay leisure resources, such as gay saunas. We aimed to analyze from studies on gender and masculinities, how sexuality, perception of HIV infection and other sexually transmitted infections (STIs), and preventive measures are articulated in gay sauna male sex workers (MSW). Ten in-depth interviews and observation were conducted between 2012 and 2016. Safe sex practices are more frequent with clients, while risk practices are carried out more with non-commercial partners. Sexual orientation plays an important role. Homosexuals assume riskier practices in sex work than heterosexuals. Drug use or lack of support networks were associated with higher social vulnerability and risk behaviors. Contracting HIV still creates fear, while having other STIs is perceived as part of a man's sexual life. The MSW affirms masculinity with concurrent sexual partners, breadwinner, and on the other hand, questions a heteronormative model. Interventions for the prevention of HIV and STIs in this group should consider social determinants such as inferior work alternatives and the provision of more significant social support.

Male sex workers: between safe sex and risk. Ethnography in a gay sauna in Barcelona, Spain. / Trabajadores sexuales masculinos: entre el sexo seguro y el riesgo. Etnografía en una sauna gay de Barcelona, España.

This ethnography was conducted in Barcelona, a city that provides different gay leisure resources, such as gay saunas. We aimed to analyze from studies on gender and masculinities, how sexuality, perception of HIV infection and other sexually transmitted infections (STIs), and preventive measures are articulated in gay sauna male sex workers (MSW). Ten in-depth interviews and observation were conducted between 2012 and 2016. Safe sex practices are more frequent with clients, while risk practices are carried out more with non-commercial partners. Sexual orientation plays an important role. Homosexuals assume riskier practices in sex work than heterosexuals. Drug use or lack of support networks were associated with higher social vulnerability and risk behaviors. Contracting HIV still creates fear, while having other STIs is perceived as part of a man's sexual life. The MSW affirms masculinity with concurrent sexual partners, breadwinner, and on the other hand, questions a heteronormative model. Interventions for the prevention of HIV and STIs in this group should consider social determinants such as inferior work alternatives and the provision of more significant social support.

Esta etnografía se realizó en Barcelona, ciudad que ofrece diferentes recursos de ocio homosexual, como las saunas gay. El objetivo fue analizar desde los estudios sobre género y masculinidades, cómo se articula la sexualidad, la percepción sobre la infección por VIH y otras infecciones de transmisión sexual (ITS), y las medidas preventivas en trabajadores sexuales masculinos (TSM) usuarios de saunas gay. Se realizaron 10 entrevistas en profundidad y observación entre 2012 y 2016. Las prácticas de sexo seguro son más frecuentes con clientes, mientras que las de riesgo se realizan más con parejas no comerciales. La orientación sexual juega un rol relevante, los homosexuales asumen más prácticas de riesgo en el trabajo sexual que los heterosexuales. Consumo de drogas o la escasez de redes de apoyo se relacionaron con mayor vulnerabilidad social y conductas de riesgo. Contraer el VIH aún genera miedo, mientras que tener otras ITS se percibe como parte de la vida sexual de un hombre. El TSM afianza una masculinidad con múltiples parejas sexuales, breadwinner y por otra parte, cuestiona un modelo heteronormativo. Las intervenciones para la prevención del VIH e ITS en este colectivo, deberían considerar los determinantes sociales como las precarias alternativas laborales y el ofrecer mayor soporte social.

Recent epidemiology of sexually transmissible enteric infections in men who have sex with men.

PURPOSE OF REVIEW: Sexual transmission of enteric pathogens in men who have sex with men (MSM) has been described since the 1970s. Recently, an increasing number of enteric infection outbreaks have been reported in MSM. This article summarizes recent outbreaks and discusses the key issues for prevention and control. RECENT FINDINGS: Sexually transmissible enteric infections (STEIs) can spread rapidly and internationally within highly connected MSM populations and are often associated with antimicrobial resistance (AMR). The infections often cluster in high-risk groups of HIV-positive MSM who are more likely to engage in diverse sexual practices and chemsex, and to have multiple other sexually transmitted infections (STIs). SUMMARY: The roles of asymptomatic and/or persistent infection and other contextual factors in STEI transmission are not well described. STEI-associated AMR is increasing and has potential to spread rapidly in MSM, warranting further public health attention. A better understanding of the factors associated with sexual transmission will enable the development of more effective control measures. A holistic approach that promotes health and wellbeing as well as infection prevention and management is needed.

Gonorrhea Control, United States, 1972-2015, A Narrative Review.

Gonorrhea is the second most commonly reported infection. It can lead to pelvic inflammatory disease, ectopic pregnancy, and infertility. Rates of gonorrhea decreased after the National Gonorrhea Control Program began in 1972, but stabilized in the mid 1990s. The emergence of antimicrobial resistant strains increases the urgency for enhanced gonorrhea control efforts. To identify possible approaches for improving gonorrhea control, we reviewed historic protocols, reports, and other documents related to the activities of the National Gonorrhea Control Program using Centers for Disease Control and Prevention records and the published literature. The Program was a massive effort that annually tested up to 9.3 million women, and treated up to 85,000 infected partners and 100,000 additional exposed partners. Reported gonorrhea rates fell by 74% between 1976 and 1996, then stabilized. Testing positivity was 1.6-4.2% in different settings in 1976. In 1999-2008, the test positivity of a random sample of 14- to 25-year-olds was 0.4%. Gonorrhea testing rates remain high, however, partner notification efforts decreased in the 1990s as attention shifted to human immunodeficiency virus and other sexually transmitted diseases. The decrease and subsequent stabilization of gonorrhea rates was likely also influenced by changes in behavior, such as increases in condom use in response to acquired immune deficiency syndrome. Renewed emphasis on partner treatment might lead to further decreases in rates of gonorrhea.

How to assess gay, bisexual and other men who have sex with men for chemsex.

OBJECTIVES: Sexualised substance use, 'chemsex', is being increasingly reported by gay, bisexual and other men who have sex with men (GBMSM) in sexual health clinics. We aim to describe the evidence base and practical ways in which clinicians can assess and advise patients disclosing chemsex. METHODS: We review published literature on chemsex, discuss vulnerability to substance use, highlight the importance of clinical communication and discuss a management approach. RESULTS: GBMSM are vulnerable to substance use problems, which interplay with mental, physical and sexual health. Knowledge on sexualised drug use and related communication skills are essential to facilitating disclosure. Identifying sexual health and other consequences of harmful drug use may motivate patients to seek change. CONCLUSIONS: Sexual health clinicians are well placed to make more holistic assessments of GBMSM accessing their services to promote broader sexual health and well-being beyond the management of HIV and sexually transmitted infections (STIs) alone.

Adolescent Pregnancy Guidelines.

OBJECTIVE: To describe the needs and evidence-based practice specific to care of the pregnant adolescent in Canada, including special populations. OUTCOMES: Healthy pregnancies for adolescent women in Canada, with culturally sensitive and age-appropriate care to ensure the best possible outcomes for these young women and their infants and young families, and to reduce repeat pregnancy rates. EVIDENCE: Published literature was retrieved through searches of PubMed and The Cochrane Library on May 23, 2012 using appropriate controlled vocabulary (e.g., Pregnancy in Adolescence) and key words (e.g., pregnancy, teen, youth). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Results were limited to English or French language materials published in or after 1990. Searches were updated on a regular basis and incorporated in the guideline to July 6, 2013. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, national and international medical specialty societies, and clinical practice guideline collections. VALUES: The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS/HARMS/COSTS: These guidelines are designed to help practitioners caring for adolescent women during pregnancy in Canada and allow them to take the best care of these young women in a manner appropriate for their age, cultural backgrounds, and risk profiles. RECOMMENDATIONS: 1. Health care providers should adapt their prenatal care for adolescents and offer multidisciplinary care that is easily accessible to the adolescent early in the pregnancy, recognizing that adolescents often present to care later than their adult counterparts. A model that provides an opportunity to address all of these needs at one site may be the preferred model of care for pregnant adolescents. (II-1A) 2. Health care providers should be sensitive to the unique developmental needs of adolescents through all stages of pregnancy and during intrapartum and postpartum care. (III-B) 3. Adolescents have high-risk pregnancies and should be managed accordingly within programs that have the capacity to manage their care. The unique physical risks of adolescent pregnancy should be recognized and the care provided must address these. (II-1A) 4. Fathers and partners should be included as much as possible in pregnancy care and prenatal/infant care education. (III-B) 5. A first-trimester ultrasound is recommended not only for the usual reasons for properly dating the pregnancy, but also for assessing the increased risks of preterm birth. (I-A) 6. Counselling about all available pregnancy outcome options (abortion, adoption, and parenting) should be provided to any adolescent with a confirmed intrauterine gestation. (III-A) 7. Testing for sexually transmitted infections (STI) (II-2A) and bacterial vaginosis (III-B) should be performed routinely upon presentation for pregnancy care and again in the third trimester; STI testing should also be performed postpartum and when needed symptomatically. a. Because pregnant adolescents are inherently at increased risk for preterm labour, preterm birth, and preterm pre-labour rupture of membranes, screening and management of bacterial vaginosis is recommended. (III-B) b. After treatment for a positive test, a test of cure is needed 3 to 4 weeks after completion of treatment. Refer partner for screening and treatment. Take the opportunity to discuss condom use. (III-A) 8. Routine and repeated screening for alcohol use, substance abuse, and violence in pregnancy is recommended because of their increased rates in this population. (II-2A) 9. Routine and repeated screening for and treatment of mood disorders in pregnancy is recommended because of their increased rates in this population. The Edinburgh Postnatal Depression Scale administered in each trimester and postpartum, and more frequently if deemed necessary, is one option for such screening. (II-2A) 10. Pregnant adolescents should have a nutritional assessment, vitamins and food supplementation if needed, and access to a strategy to reduce anemia and low birth weight and to optimize weight gain in pregnancy. (II-2A) 11. Conflicting evidence supports and refutes differences in gestational hypertension in the adolescent population; therefore, the care usual for adult populations is supported for pregnant adolescents at this time. (II-2A) 12. Practitioners should consult gestational diabetes mellitus (GDM) guidelines. In theory, testing all patients is appropriate, although rates of GDM are generally lower in adolescent populations. Practitioners should be aware, however, that certain ethnic groups including Aboriginal populations are at high risk of GDM. (II-2A) 13. An ultrasound anatomical assessment at 16 to 20 weeks is recommended because of increased rates of congenital anomalies in this population. (II-2A) 14. As in other populations at risk of intrauterine growth restriction (IUGR) and low birth weight, an ultrasound to assess fetal well-being and estimated fetal weight at 32 to 34 weeks gestational age is suggested to screen for IUGR. (III-A) 15. Visits in the second or third trimester should be more frequent to address the increased risk of preterm labour and preterm birth and to assess fetal well-being. All caregivers should be aware of the signs and symptoms of preterm labour and should educate their patients to recognize them. (III-A) 16. It should be recognized that adolescents have improved vaginal delivery rates and a concomitantly lower Caesarean section rate than their adult counterparts. (II-2A) As with antenatal care, peripartum care in hospital should be multidisciplinary, involving social care, support for breastfeeding and lactation, and the involvement of children's aid services when warranted. (III-B) 17. Postpartum care should include a focus on contraceptive methods, especially long-acting reversible contraception methods, as a means to decrease the high rates of repeat pregnancy in this population; discussion of contraception should begin before delivery. (III-A) 18. Breastfeeding should be recommended and sufficient support given to this population at high risk for discontinuation. (II-2A) 19. Postpartum care programs should be available to support adolescent parents and their children, to improve the mothers' knowledge of parenting, to increase breastfeeding rates, to screen for and manage postpartum depression, to increase birth intervals, and to decrease repeated unintended pregnancy rates. (III-B) 20. Adolescent women in rural, remote, northern, and Aboriginal communities should be supported to give birth as close to home as possible. (II-2A) 21. Adolescent pregnant women who need to be evacuated from a remote community should be able to have a family member or other person accompany them to provide support and encouragement. (II-2A) 22. Culturally safe prenatal care including emotional, educational, and clinical support to assist adolescent parents in leading healthier lives should be available, especially in northern and Aboriginal communities. (II-3A) 23. Cultural beliefs around miscarriage and pregnancy issues, and special considerations in the handling of fetal remains, placental tissue, and the umbilical cord, must be respected. (III).

Objectif : Décrire les besoins des adolescentes enceintes au Canada (y compris celles qui sont issues de populations particulières) et les pratiques factuelles propres aux soins qui doivent être offerts à ces femmes. Issues : Grossesses saines chez les adolescentes au Canada; offre de soins sûrs au plan culturel et adaptés à l'âge pour assurer l'obtention des meilleures issues possibles pour ces jeunes femmes, leurs enfants et leur famille; et réduction des taux de grossesse à répétition. Résultats : La littérature publiée a été récupérée par l'intermédiaire de recherches menées dans PUBMED et The Cochrane Library le 23 mai 2012, au moyen d'un vocabulaire contrôlé (p. ex. « Pregnancy in Adolescence ¼) et de mots clés (p. ex. « pregnancy ¼, « teen ¼, « youth ¼) appropriés. Les résultats ont été restreints aux analyses systématiques, aux études observationnelles et aux essais comparatifs randomisés / essais cliniques comparatifs. Les résultats ont été limités aux articles publiés en anglais ou en français à partir de 1990. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusqu'au 6 juillet 2013. La littérature grise (non publiée) a été identifiée par l'intermédiaire de recherches menées dans les sites Web d'organismes s'intéressant à l'évaluation des technologies dans le domaine de la santé et d'organismes connexes, dans des collections de directives cliniques, dans des registres d'essais cliniques et auprès de sociétés de spécialité médicale nationales et internationales. Valeurs : La qualité des résultats a été évaluée au moyen des critères décrits dans le rapport du Groupe d'étude canadien sur les soins de santé préventifs (Tableau). Avantages, désavantages et coûts : La présente directive clinique a été conçue pour aider les praticiens canadiens à offrir aux adolescentes enceintes des soins optimaux qui sont adaptés à leur âge, à leur contexte culturel et à leurs profils de risque. Recommandations 1. Les professionnels de la santé devraient adapter leurs services prénataux aux besoins des adolescentes et leur offrir des soins multidisciplinaires dont elles pourront facilement se prévaloir tôt dans le cadre de la grossesse, en tenant ainsi compte du fait que les adolescentes sollicitent souvent des soins plus tard que leurs homologues adultes. Un modèle de soins permettant de répondre à tous ces besoins en un seul et même endroit pourrait constituer le modèle à privilégier pour les adolescentes enceintes. (II-1A) 2. Les fournisseurs de soins devraient être sensibles aux besoins développementaux particuliers des adolescentes tout au long de la grossesse, ainsi que dans le cadre des soins intrapartum et postpartum. (III-B) 3. Chez les adolescentes, la grossesse est exposée à des risques élevés et devrait faire l'objet d'une prise en charge adaptée en conséquence dans le cadre de programmes disposant des capacités nécessaires. Les risques physiques propres à la grossesse chez une adolescente doivent être pris en considération et les soins offerts doivent s'y adapter. (II-1A) 4. La participation des pères et des partenaires aux cours prénataux (soins à prodiguer à la mère et à l'enfant) devrait être favorisée autant que possible. (III-B) 5. La tenue d'une échographie au cours du premier trimestre est recommandée non seulement aux fins de la datation adéquate de la grossesse (soit la raison habituellement invoquée pour la tenue d'une telle intervention), mais également pour l'évaluation des risques accrus d'accouchement préterme. (I-A) 6. Des services de counseling traitant de toutes les options disponibles en ce qui concerne la grossesse (avortement, adoption et parentage) devraient être offerts à toutes les adolescentes chez qui la présence d'une grossesse intra-utérine a été confirmée. (III-A) 7. Un dépistage visant les infections transmissibles sexuellement (II-2A) et la vaginose bactérienne (III-B) devrait être mené systématiquement dans le cadre de la première consultation prénatale et, une fois de plus, au cours du troisième trimestre; un dépistage visant les infections transmissibles sexuellement devrait également être mené pendant la période postpartum et lorsque la présence de symptômes en justifie la mise en œuvre. a. Puisque les adolescentes enceintes sont intrinsèquement exposées à des risques accrus de travail préterme, d'accouchement préterme et de rupture prématurée des membranes préterme, elles constituent un « groupe exposé à des risques élevés ¼ : le dépistage et la prise en charge de la vaginose bactérienne s'avèrent donc recommandée. (III-B) b. À la suite d'un traitement mis en œuvre en raison de l'obtention d'un résultat positif au dépistage, la tenue d'un test de contrôle post-traitement s'avère requise de trois à quatre semaines à la suite de la fin du traitement. L'orientation du partenaire vers des services de dépistage et de traitement s'avère également requise. Les fournisseurs de soins devraient profiter de l'occasion pour discuter de l'utilisation de condoms avec leurs patientes. (III-A) 8. La mise en œuvre systématique et répétée d'un dépistage de la consommation d'alcool, de la consommation de substances psychoactives et de la violence pendant la grossesse est recommandée, en raison de leurs taux accrus au sein de cette population. (II-2A) 9. La mise en œuvre systématique et répétée d'un dépistage et d'une prise en charge des troubles de l'humeur pendant la grossesse est recommandée, en raison des taux accrus de ces troubles au sein de cette population. L'administration de l'Échelle de dépression postnatale d'Édimbourg à chaque trimestre et pendant la période postpartum (et plus fréquemment, lorsque cela semble nécessaire) constitue une option pour la mise en œuvre d'un tel dépistage. (II-2A) 10. Les adolescentes enceintes devraient faire l'objet d'une évaluation nutritionnelle et d'une supplémentation en vitamines et en aliments (au besoin), ainsi qu'obtenir accès à une stratégie visant l'optimisation du gain pondéral pendant la grossesse et la baisse des risques d'anémie et de faible poids de naissance. (II-2A) 11. Des données contradictoires soutiennent et réfutent la présence de différences en matière d'hypertension gestationnelle au sein de la population adolescente; ainsi, nous soutenons pour l'instant l'offre, aux adolescentes enceintes, des soins qui sont habituellement offerts aux populations adultes. (II-2A) 12. Les praticiens devraient consulter les lignes directrices traitant du diabète sucré gestationnel. En théorie, le dépistage de toutes les patientes s'avère approprié, et ce, bien que les taux de diabète sucré gestationnel soient généralement moindres chez les populations adolescentes. Les praticiens devraient cependant être avisés que certains groupes ethniques (dont les populations autochtones) sont exposés à des risques élevés de diabète sucré gestationnel. (II-2A) 13. La tenue d'une échographie d'évaluation anatomique à 16-20 semaines est recommandée, en raison des taux accrus d'anomalies congénitales au sein de cette population. (II-2A) 14. Tout comme dans le cas d'autres populations exposées à des risques de retard de croissance intra-utérin et de faible poids de naissance, la tenue d'une échographie visant à évaluer le bien-être fœtal et à estimer le poids fœtal à un âge gestationnel de 32-34 semaines est suggérée pour le dépistage du retard de croissance intra-utérin. (III-A) 15. Au cours du deuxième ou du troisième trimestre, les consultations devraient être plus fréquentes pour traiter des risques accrus de travail et d'accouchement prétermes, et pour évaluer le bien-être fœtal. Tous les fournisseurs de soins devraient connaître les symptômes du travail préterme et former leurs patientes de façon à ce qu'elles puissent les reconnaître. (III-A) 16. On se doit de souligner que les adolescentes comptent des taux d'accouchement vaginal supérieurs et (de façon concomitante) des taux de césarienne inférieurs, par comparaison avec leurs homologues adultes. (II-2A) Tout comme dans le cas des soins prénataux, les soins peripartum prodigués à l'hôpital devraient être de nature multidisciplinaire, mettre en jeu le milieu social, soutenir l'allaitement et la lactation, et solliciter la participation des services de protection de l'enfance, lorsque cela s'avère justifié. (III-B) 17. Les soins postpartum devraient comprendre une composante traitant des modes de contraception (particulièrement des contraceptifs réversibles à action prolongée), dans le but d'abaisser les taux élevés de nouvelle grossesse chez les adolescentes; les discussions au sujet de la contraception devraient débuter avant l'accouchement. (III-A) 18. L'allaitement devrait être recommandé et du soutien suffisant devrait être offert à cette population exposée à des risques élevés d'abandon. (II-2A) 19. Des programmes de soins postpartum visant la hausse des connaissances parentales et des taux d'allaitement, le dépistage et la prise en charge de la dépression postpartum, le prolongement des intervalles entre les grossesses et la réduction des taux de grossesse non souhaitée à répétition devraient être offerts pour soutenir les parents adolescents et leurs enfants. (III-B) 20. Au sein des collectivités autochtones, rurales, éloignées et du Nord, les adolescentes devraient bénéficier du soutien nécessaire à la tenue de l'accouchement le plus près possible de leur foyer. (II-2A) 21. Les adolescentes enceintes qui doivent être évacuées d'une collectivité éloignée devraient pouvoir se faire accompagner par un membre de la famille (ou toute autre personne de leur choix) à des fins de soutien et d'encouragement. (II-2A) 22. Des soins prénataux sûrs au plan culturel (y compris des mesures de soutien affectif, pédagogique et clinique aidant les parents adolescents à mener une vie leur assurant la santé) doivent être offerts, et ce, particulièrement au sein des collectivités autochtones et du Nord. (II-3A) 23. Les croyancesculturelles (entourant la fausse couche et les problèmes de la grossesse) et les considérations particulières (en ce qui concerne la manipulation des restes fœtaux, des tissus placentaires et du cordon ombilical) doivent être respectées. (III).

Reflection on care in recurrent sexually transmitted co-infections.

Reflection is a skill that nurses are expected to practise to help them continually re-evaluate their personal effectiveness in problem solving. This skill is necessary when caring for patients who are experiencing the complex challenges linked to psychosexual and psychosociological behavioural changes associated with HIV infection and recurrent sexually transmitted co-infections (STC-I). The Johns model of structured reflection was used in the reflection described here to aid the critical thinking process in helping a nurse to manage and deliver up-to-date, effective care and to develop a strong nurse-patient therapeutic relationship. A holistic approach is key to delivering care to patients with recurrent STC-I. This involves taking a sexual health history and establishing the correct diagnosis, followed by the administration of pharmaceutical and psychotherapeutic treatments to facilitate psychosexual, psychosocial, and psychological changes. This article uses a reflective learning experience in caring for a patient with recurrent STC-I to give insights on psychosexual and psychosociological behavioural strategies. Used with a diagnosis and pharmacological intervention, these strategies can be put into nursing practice and enhance the quality of nursing care.

Sex and relationships on the street: how homeless men judge partner risk on Skid Row.

Homeless men in the U.S. represent a large and growing population, and have elevated rates of HIV/AIDS and sexual risk behaviors, including unprotected sex with women. We conducted qualitative interviews (n = 30) with homeless men using shelters and meal lines in downtown Los Angeles (Skid Row) to better understand how such men view the risks of sexual encounters with female partners. Men living on Skid Row perceived multiple risks, including HIV and unwanted pregnancy as well as emotional trauma, loss of resources, exacerbation of drug addiction, and physical attack. Respondents described using visual and behavioral cues, social reputation, geographical location, feelings of trust, perceived relationship seriousness, and medically inaccurate "folk" beliefs to judge whether partners were risky and/or condom use was warranted. Medically inaccurate beliefs suggest the potential utility of evidence-based interventions to change such beliefs. We also consider implications for relationships on the street and housing interventions.

Project genesis: self-reported religiosity and spirituality and sexual risk-taking in young African-American women attending a historically African-American college.

This pilot study explored the relationship between self-reported religiosity, spirituality, and sexual risk-taking. The participants were a convenience sample of (N = 100) female students attending a historically African-American college (HBCU) in the south. On this predominantly female campus, students completed an anonymous health-risk survey, plus additional items, to measure their religiosity and spirituality. Correlation analysis revealed that although these students reported a high degree of religiosity and spirituality, these characteristics did not predict a decrease in sexual risk-taking behavior. Over six million new cases of sexually transmitted infections (STIs), including the human papilloma virus (HPV), are projected in young Americans despite primary prevention measures. Although no predictive relationships were noted, self-reported spirituality or religiosity were not protective factors against high-risk sexual behavior. These findings are relevant to developing effective interventions in this population in order to decrease STI/HPV rates.

The Internet profiles of men who have sex with men within bareback websites.

The Internet has become a venue for men who have sex with men to search for sexual partners. Some of these men intentionally seek unprotected anal intercourse with other men ('bareback' sex). This paper focuses on the creation, use, and content of Internet personal profiles of men who have sex with men in the greater New York City metropolitan area who use bareback sites for sexual networking. We used a mixed-methods approach to examine data from a cybercartography of Internet sites conducted during the first phase of the research (199 personal profiles) and from in-depth interviews conducted during its second phase (120 men who have sex with men who sought partners online for bareback sex). Results indicate that men generally followed offline stereotypical patterns in their online profiles. However, men who disclosed being HIV-positive were more likely to include face and head pictures. Overall, the images they used were heavily sexualised in accordance with group norms perceived and reinforced by the websites' design and imagery. Bottom-identified men tended to be more explicit in the exposition of their sexual and drug use interests online. This paper highlights how certain virtual and social performances play upon and reinforce other, in the flesh, performances.

East African discourses on khat and sex.

AIM OF THE STUDY: The study aims to review and analyse the varied East African discourses on the effects of khat use on libido, fertility, transmission of HIV, prostitution and rape. MATERIALS AND METHODS: The data were gathered between 2004 and 2009 in Kenya and Uganda. Between 2004 and 2005 across Kenya and Uganda a broad survey approach was adopted, involving identification of and travel to production areas, interviews with producers and consumers in rural and urban settings. In addition, a survey of 300 Ugandan consumers was carried out in late 2004. Between 2007 and 2009, an in-depth study of khat production, trade and consumption was conducted in Uganda. This study also employed a mixture of methods, including key informant interviews participant-observation and a questionnaire survey administered to 210 khat consumers. RESULTS: Khat is associated, by consumers and its detractors alike, with changes in libido and sexual performance. Although there is no evidence to support their claims, detractors of khat use argue that khat causes sexual violence, causes women to enter sex work, and that chewing causes the spread of sexually transmitted diseases, including the HIV virus. CONCLUSIONS: In East Africa the discourse on khat and sex has led to consumption of the substances being associated by many people with uncontrolled sexual behaviour. There is no evidence that khat use fuels promiscuity, commercial sex, sexually transmitted diseases or rape. The current discourse on khat and sex touches on all these topics. Local religious and political leaders invoke khat use as a cause of what they argue is a breakdown of morals and social order. In Kenya and Uganda it is women khat consumers who are seen as sexually uncontrolled. In Uganda, the argument is extended even to men: with male khat chewers labelled as prone to commit rape.

Sociocultural facilitators and barriers to condom use during anal sex among men who have sex with men in Guangzhou, China: an ethnographic study.

This ethnographic study explored how cultural belief systems shaped sexual risk practices among men who have sex with men (MSM) in Guangzhou, China. A specific focus was on how these men's sexual practices varied across sexual venues and among different partners in order to better understand sociocultural facilitators and barriers to condom use in the Guangzhou community. Qualitative data were obtained through semi-structured in-depth interviews with MSM and ethnographic observations in MSM sexual venues in the city. The thematic analysis focused specifically on the accounts of unprotected sex occasions. We found that an erotic idea of "rouyu" (desire of physical flesh) embedded in a subculture of MSM and a metaphor for condom use as being inferior and promoting distance posed a considerable barrier to condom use among these MSM. Some men reported gaining a positive self-concept related to same-sex identity through unprotected sex. These MSM's subjective evaluations of HIV risk were closely tied to the perceived characteristics of sex partners and sexual venues. We conclude by advocating specific sociocultural interventions in emerging risk venues, such as saunas/bathhouses, to better meet the needs of the MSM community in Guangzhou.

Linking HIV and sexual and reproductive health services to enhance program outcomes.

Sexual and reproductive health services provide an opportunity to achieve universal access to HIV prevention and care and should be part of a national strategic response. There is recognition that HIV is a sexually transmitted infection or associated with pregnancy, childbirth, and breastfeeding. Both address the same target population and the vulnerability to risk and underlying causes are essentially the same. Providing comprehensive services that prevent HIV transmission, including to infants, those that meet the fertility intentions of people living with HIV, and management and prevention of sexually transmitted infections are some of the key elements of these linkages. Approaches that have shown success in HIV prevention and care include those in which a combination of strategies has been deployed, both in prevention and treatment regimens, and the combination of services delivery should yield equally positive results. Some strategies and recommendations detailed at the International Federation of Gynecology and Obstetrics (FIGO) World Congress in 2009 are discussed that could increase the effective response to the global response to HIV.

Vaginal practices: eroticism and implications for women's health and condom use in Mozambique.

This paper analyses two female sexual practices in Tete Province, Mozambique: (1) the practice of elongating the labia minora and (2) what is sometimes called 'dry sex' involving the insertion of natural and/or synthetic products into the vagina or the ingestion of these products orally. These practices are fundamental to the construction of female identity, eroticism and the experience of pleasure. Notions such as 'closed/open', 'dry/damp', 'hot/cold', 'heavy/light', 'life/death', 'wealth/poverty' and 'sweet/not sweet' are central to local understandings of sexual practices and reproduction. These notions may affect the women's sexual health because they influence preferences for sex without a condom. These practices may also be associated with the alteration of the vaginal flora and vaginal lesions that may make women more vulnerable to sexually transmitted infections.

Integrating multidimensional HIV prevention programs into healthcare settings.

Effective secondary prevention programs to reduce HIV transmission risk-relevant behaviors among HIV-infected individuals must go beyond the traditional, common sense prevention components to develop biomedically and epidemiologically informed behavioral interventions as part of comprehensive, integrated, multidisciplinary HIV care. Incorporating and expanding on the Serostatus Approach to Fighting the Epidemic, a five-pronged strategy set forth by the Centers for Disease Control and Prevention in 2001, we discuss recent findings from the biomedical sciences on viral and host factors that influence infectiousness to support the idea that the most proactive prevention programs will explicitly integrate biomedical interventions and approaches designed to reduce infectiousness, and thus the sexual transmission of HIV. Based on studies of emerging and spreading drug-resistant HIV variants, we have posited the potential development of biodisparity as the biological entrenchment of disparities in socioeconomic status, access to care, and HIV risk-relevant behaviors that differentially affect minorities living with HIV in the US. It is clear that creative approaches based on an expanded behavioral medicine interface with the latest HIV biomedical and epidemiological research are needed to enhance the efficacy of HIV secondary prevention.

Tracking coverage on the silk road: time to turn theory into practice.

Scaling up coverage of programs that effectively reduce the spread of HIV among vulnerable populations, including injecting drug users (IDUs), sex workers (SWs), and men who have sex with men (MSM), is a critically important issue for many countries today. However, in addition to the lack of a commonly accepted definition of coverage, there are currently no universally accepted standards, methodologies, or tools to track coverage among these groups. Globally, most programs working to prevent HIV among vulnerable populations are not using monitoring & evaluation (M&E) systems that accurately track numbers of clients and frequency of contact with those clients. Nor do most programs have targets on the frequency of contact needed to effectively promote healthy behaviours. This article presents a narrative of how one program in Central Asia developed a simple M&E system to track the extent and frequency of contacts among clients. The system uses a simple and anonymous "Unique Identifier Code" (UIC) that is assigned to each client and recorded into a simple database to track the client's interaction with the program. The system allows program managers to track numbers of clients served and at what frequency and to better monitor progress towards goals. The data produced by the UIC system, when compared against HIV and sexually transmitted infection (STI) sentinel surveillance data by site, allows programs to test theorized definitions of the quantity of coverage needed to reduce the risk behaviours that spread HIV among vulnerable populations. Such systems can then provide urgently needed data to help national HIV/AIDS programs understand current coverage levels and gaps in coverage that need to be filled in order to reduce the spread of HIV. Such a system provides valuable data to enable decision makers to make evidence-based decisions on how to allocate resources to reach sufficient coverage to reduce the spread of HIV among populations most at risk of HIV.