"Sex is supposed to be naturally more pleasurable": Healers as providers of holistic sexual and reproductive healthcare in Uganda.

Global health researchers often approach Traditional, Complementary, and Alternative Medicine (TCAM) from a health efficacy perspective, asking whether the presence of plural medical systems helps or hinders the uptake of biomedicine. Medical anthropologists, by contrast, typically emphasize how plural medical systems encourage us to rethink health ontologies-that is, who and what comes to constitute the experience of health and illness, and through which practices. Building on both approaches, we explore the role of "healers," a term we use to encompass several different kinds of TCAM providers, in the sexual and reproductive healthcare (SRH) of young people from southcentral Uganda, a region well known as an HIV/AIDS epicenter. Drawing from ethnographic data, we describe three reasons that young people seek SRH from healers. First, they associate stigma, scarcity, and high costs with biomedical SRH. Second, healers work across biomedical and non-biomedical therapeutic divides, prescribing herbs for sexually transmitted infections while simultaneously referring clients to biomedical HIV clinics. Third, healers provide counseling focused on pleasurable and economically-motivated sex. Because these therapies diverge from international and national HIV prevention messaging that frames non-marital and transactional sex in terms of danger and disease, healers' holistic approach to SRH may help to reconstitute the meaning, practice, and experience of "sexual health" in contemporary Uganda. This has important implications for improving global SRH programs and for understanding the continued appeal of TCAM more generally.

Patterns of comorbidity and sociodemographic and psychosocial correlates among people living with HIV in South Carolina, USA.

OBJECTIVES: Prevention of comorbidity with HIV infection warrants more attention as people living with HIV (PLWH) tend to live longer in the era of effective antiretroviral therapy (ART). This study aimed to investigate the associations between various psychosocial variables and different comorbid conditions in South Carolina (SC), USA. METHODS: A cross-sectional survey was conducted among PLWH from May to September 2018 in SC. Comorbid conditions were based on self-report data and grouped into sexually transmitted infection (STI) comorbidities, noninfectious chronic comorbidities or any comorbidity. Multivariate logistic regression models were used to analyse the relevant associations. RESULTS: Among 402 participants, the prevalence of STI comorbidities, noninfectious chronic comorbidities, and any comorbidity was 61.7%, 21.9% and 69.4%, respectively. The multivariate analysis showed that higher depression scores were associated with an increased risk of any comorbidity, while higher anxiety scores were associated with an increased risk of STI comorbidities or any comorbidity. Higher resilience scores were associated with a decreased risk of noninfectious chronic comorbidities or any comorbidity. CONCLUSIONS: The association between psychosocial factors and different types of comorbidity could inform holistic interventions, such as providing integrated mental health services (e.g. treating mental health problems or building resilience), to effectively cope with and manage the co-existing medical conditions of PLWH.

JUSTIFICATION OF THE NECESSITY OF INTEGRATED MEDICAL CARE FOR PATIENTS SUFFERING FROM SOCIALLY SIGNIFICANT DISEASES (BASED ON THE RESULTS OF THE TARGET GROUP SURVEY).

The diseases of social significance are one of the biggest threats of people's health and well-being all over the world and a great burden for the healthcare system and community in general. It is widely known that the consequences of most of such diseases include temporary or permanent loss of working ability and continuous significant investments of money in the prediction, curing, and rehabilitation measures. The increase in the number of individuals with deviant behavior, especially among teenagers and young people, social disadaptation, migration of people, insufficient government funding for healthcare and social sphere concerning prevention of diseases of social significance and diseases linked with social status - all these factors create the background for the further complication of the STIs epidemic situation in Ukraine. It is scientifically proven that raising the quality of help given people with STIs and increasing its accessibility for different social strata, particularly for the representatives of the target groups, is an effective method for decreasing the rate of parenteral hepatitis and HIV infections in society. The aim of the current research is to assess the quality of the specialized help given patients with STIs (on the example of HIV-infected persons) in order to implement the integrated system of medical and social rehabilitation considering the features of the target group. The survey was conducted on the basis of designed questionnaires which included questions regarding the level of education, social status, necessity and frequency of appeals for medical help, particularly for dermatovenereological help, the affordability and comprehensiveness of the latter, the level of satisfaction with the received medical care, the respondent's assessment of quality and modernity of medical equipment. 389 questionaries' served as material for the research. Each questionnaire was composed of 15 questions. The respondents included 201 males and 188 females diagnosed with HIV-infection, who permanently live in Odessa region. Methods of research: analytical, descriptive, and statistical. The majority of HIV-infected respondents received incomplete secondary, complete secondary or vocational secondary education, 10,28% of them (40 respondents) received incomplete or complete higher education, which characterized the cohort of respondents as people with low level of education, social and sexual awareness. 24,16% of respondents (94 persons) were permanently employed; the others - were unemployed due to different reasons, and, consequently, had low social security level. More than half of respondents (220 individuals - 56,56%) were dissatisfied by the quality of dermatovenereological medical help due to the lack of medical equipment. Only 76 respondents (19,54%) were completely satisfied and positively characterized the latter. The necessity of the establishment of the specialized center of dermatovenereological help for HIV-infected patients was pointed out by 226 respondents (58,10%). The vast majority of HIV-infected respondents (80,98%) expresses quite strong opinion regarding the necessity of the establishment of multiprofile health care institution, which would provide the whole spectrum of medical services, taking into consideration the specific features of HIV-infected patients.

The knowledge-risk-behaviour continuum among young Ugandans: what it tells us about SRH/HIV integration.

BACKGROUND: With a human immunodeficiency virus (HIV) prevalence of 2.1% among 15-24 year olds, opportunities for further integration of sexual and reproductive health (SRH) and HIV prevention services for young people in Uganda exist. We examine a range of factors that contribute to variance in risky sexual behaviour among young Ugandans. METHODS: A cross-sectional, nationally representative household survey was conducted between February and March 2016. The questionnaire used assessed knowledge, attitudes and practices related to SRH among young people aged 10-24 years. A composite indicator was constructed to assess risky sexual behaviour, defined as being involved in sexual relations under the influence of alcohol or drugs, engaging in sexual activities without a condom, and having multiple sexual partners in the 6 months preceding the survey. Exploratory analysis was conducted to provide descriptive statistics. Logistic regression was conducted to determine the factors associated with risky sexual behaviour. This analysis focuses on the sub-category aged 15-24 years, comprised of 2725 respondents. RESULTS: Knowledge levels of family planning (FP), sexually transmitted infections (STIs) and HIV across all respondents were high (above 82%). Self-reported perceived risk of STIs and pregnancy was consistently higher among 20-24 year old respondents, with 61.5% feeling at risk of STIs compared to 46.2% of 15-19 year olds. A total of 22.7% of respondents reported having been involved in risky sexual behaviour. Factors associated with risky sexual behaviour among the 15-19 years group included gender, single orphanhood, casual work, schooling status, FP knowledge and self-perceived risk of STIs/HIV. For the 20-24 year old respondents, significantly associated factors included gender, educational level, relationship to head of household, place of residence, and self-perceived risk of pregnancy. CONCLUSIONS: Despite high general SRH/HIV knowledge and perceived risk of pregnancy and HIV, risky sexual behaviour among young Ugandans remains high. Effectiveness gaps in the integrated SRH/HIV response for young people should be addressed and targeted interventions focused on holistic prevention at individual level through information, risk awareness, and skill development should be combined with interventions targeting social structures affecting individual behaviour.

Associations of depression and anxiety symptoms with sexual behaviour in women and heterosexual men attending sexual health clinics: a cross-sectional study.

OBJECTIVE: To assess the association of symptoms of depression and anxiety with sexual risk behaviour and history, among women and heterosexual men attending genitourinary medicine (GUM) clinics. METHODS: Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) was a cross-sectional, self-administered questionnaire study recruited from 20 GUM clinics in England, 2013-2014. This analysis included women and heterosexual men. The prevalence of depression and anxiety symptoms was assessed. Modified Poisson regression was used to produce adjusted prevalence ratios (aPR) for the association of t demographic, socioeconomic and lifestyle factors with depression and anxiety, adjusted for gender, age, ethnicity, education level and study region. Among individuals reporting sex in the past 3 months, associations of depression and anxiety with sexual risk behaviour and history were assessed separately by gender, adjusted for age, ethnicity, study region, education and relationship status. RESULTS: Questionnaires were completed by 676 women and 470 heterosexual men. Depression symptoms were reported by 100 (14.8%) women and 33 men (7.0%). Anxiety symptoms were reported by 79 women (11.7%) and 21 men (4.5%). Among women reporting recent sex, those with depression symptoms were more likely to report condomless sex with a non-regular partner, aPR 1.38 (1.07-1.77) and recent condomless sex with two or more partners, 1.80 (1.25-2.59). Women with anxiety symptoms more likely to report recent condomless sex with two or more partners, 1.68 (1.13-2.50), low self-efficacy for condom use, 1.54 (1.02-2.31) and STI diagnosis in the last year 1.51 (1.04-2.20). Among heterosexual men reporting recent sex, depression and anxiety symptoms were associated with low self-efficacy with condom use, 2.32 (1.29-4.19) for depression and 2.23 (1.26-3.94) for anxiety, but not with measures of condomless sex. DISCUSSION: The associations between psychological symptoms and sexual risk behaviours highlight the importance of holistic assessment of need by both general and sexual health clinicians. We highlight the challenge in delivering holistic care associated with fragmentation of sexual health services.

Knowledge of HIV status and antiretroviral therapy use among sexually transmitted infections service attendees and the case for improving the integration of services in South Africa: A cross sectional study.

We describe knowledge of human immunodeficiency virus (HIV) status, correct report of HIV status and antiretroviral therapy (ART) use among sexually transmitted infection (STI) service attendees in South Africa.An anonymous questionnaire was administered and serological HIV testing done. Proportions of attendees reporting knowledge of HIV status and HIV status consistent with laboratory results and ART use (among HIV positives) were determined as were factors associated with knowledge and inconsistent report of HIV status.Of 1054 attendees, 288 (27.3%) were HIV positive and 830 (78.8%) self-reported knowledge of HIV status. Not knowing one's HIV status was associated with male gender [adjusted Odds Ratio (aOR) 2.66 (95% confidence interval (CI) 1.70-4.18] medical circumcision [aOR 0.48 (95% CI 0.24-0.95)] and site [Gauteng Province (GP)-aOR 6.20 (95% CI 3.51-10.95), Eastern Cape (EC)-aOR 17.29 (95% CI 10.08- 29.66) versus Free State (FS)/Western Cape (WC) sites]. Of 219 HIV positive attendees with knowledge of HIV status, 136 (62.1%) self-reported being HIV positive, of whom 80 (58.8%) reported taking ARVs in the preceding 3 days. Inconsistent report of status was associated with males [aOR 2.26 (95%CI 1.05-4.87)], prior STI treatment [aOR 0.33 (95% CI 0.16-0.69)], recent HIV testing (6months) [aOR 3.20 (95% CI 1.62-6.36)] and site [GP-aOR 6.89 (95% 3.21-14.82), EC-aOR 5.08 (95% CI 2.15-11.64) versus FS/WC sites]. Knowledge of HIV status was lower than targeted. HIV testing and linkage to care services are essential in STI-related care and validation of self-reported indicators in this population maybe necessary.

Sexual Quality of Life and Association With HIV and Sexually Transmitted Infections Among a Cohort of Heterosexual Couples in Kenya.

INTRODUCTION: Sexual quality of life (SQoL) is a critical component of sexual health and is understudied in Sub-Saharan African settings with endemic HIV and sexually transmitted infection (STI). AIM: We sought to assess SQoL among heterosexual couples in Kisumu, Kenya, and how this was associated with HIV status, STIs, and sexual practices. METHODS: This was a prospective cohort study of community-recruited couples. SQoL, HIV status, herpes simplex virus (HSV)-2 status, bacterial vaginosis (BV), sexual practices, and sociodemographics were measured at baseline, 6 months, and 12 months. Multivariable linear regression with random intercept was fitted separately for females and males, accounting for partner characteristics. MAIN OUTCOME MEASURE: SQoL was assessed with an 18-item female and 11-item male survey. RESULTS: From April 2014 through July 2016, 252 couples were enrolled, and followed up through September 2017. At baseline, women were median age 23 years, 10% HIV positive, 53% HSV-2 seropositive, and 22% with BV. At baseline men were median age 26 years, 12% HIV positive, 47% HSV-2 seropositive, and 56% circumcised. Mean SQoL was higher for men (88) than women (78), with consistent scores over time. In multivariable analysis (P < .05 each), SQoL Questionnaire-Female (SQoL-F) score was reduced with: male partner report that sex felt rougher than he would have liked (9.5-point decrease), female HSV-2 seropositivity (5.15-point decrease), female reported having dry vaginal sex (5.27-point decrease); among women with BV, SQoL-F score declined with recent sexual activity (8.27-point decrease) and increasing age (0.75-point decrease per 1 year increase in age). Age and recent sex did not affect SQoL-F for women without BV. SQoL Questionnaire-Male score was decreased 4.99 points if male was employed, 4.52 points if male reported multiple recent sex partners, and 29.5 points for HIV positive men whose female partner reported having sex when not in the mood. Men's SQoL increased by 0.84 points for each 1-U increase in female partner body mass index and 17.6 points for HIV positive men whose female partner reported recent sex with him. CLINICAL IMPLICATIONS: Within sexual partnerships, men had greater SQoL than women, and the adverse impact of BV and STIs on SQoL was greater for women than men. STRENGTH & LIMITATIONS: Research is needed to ensure relevant domains are measured in settings where measure of SQoL has not been validated, along with robust measures of physiologic and psychologic correlates. CONCLUSION: More attention to SQoL as an outcome may strengthen interventions aimed at preventing HIV and STIs and improving sexual health holistically. Mehta SD, Nordgren RK, Agingu W, et al. Sexual Quality of Life and Association With HIV and Sexually Transmitted Infections Among a Cohort of Heterosexual Couples in Kenya. J Sex Med 2018;15:1446-1455.

Forming new sex partnerships while overseas: findings from the third British National Survey of Sexual Attitudes & Lifestyles (Natsal-3).

OBJECTIVES: Travelling away from home presents opportunities for new sexual partnerships, which may be associated with sexually transmitted infection (STI) risk. We examined the prevalence of, and factors associated with, reporting new sexual partner(s) while overseas, and whether this differed by partners' region of residence. METHODS: We analysed data from 12 530 men and women aged 16-74 years reporting ≥1 sexual partner(s) in the past 5 years in Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a probability survey undertaken 2010-2012. RESULTS: 9.2% (95% CI 8.3% to 10.1%) of men and 5.3% (4.8% to 5.8%) of women reported new sexual partner(s) while overseas in the past 5 years. This was strongly associated with higher partner numbers and other sexual and health risk behaviours. Among those with new partners while overseas, 72% of men and 58% of women reported partner(s) who were not UK residents. Compared with those having only UK partners while abroad, these people were more likely to identify as 'White Other' or 'Non-White' (vs White British ethnicity), report higher partner numbers, new partners from outside the UK while in the UK and paying for sex (men only) all in the past 5 years. There was no difference in reporting STI diagnosis/es during this time period. CONCLUSIONS: Reporting new partners while overseas was associated with a range of sexual risk behaviours. Advice on sexual health should be included as part of holistic health advice for all travellers, regardless of age, destination or reason for travel.

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.

Population-based survey on STI-associated symptoms and health-seeking behaviours among Iranian adults.

BACKGROUND: Qualified decision-making for the improved management of sexually transmitted infections (STIs) requires various sources of information. We aimed to estimate the STI-associated symptom prevalence and care-seeking patterns in the general population of Iran. METHODS: In 2014, using a street-based survey with a standard gender-specific questionnaire on STI-associated symptoms and willingness to seek treatment, we interviewed 9166 Iranian participants, who were selected from among the 18-60-year-old population using multistage sampling. Data were analysed via generalised estimating equation and survey analysis, taking into account a 95% confidence coefficient. RESULTS: About 67.3% of participants, mean age 33 years, were 'assumed sexually active' and were therefore eligible for inclusion. Approximately 39.9% (95% CI 28.4% to 51.4%) of women and 17.6% (95% CI 13.9% to 21.6%) of men reported at least one STI-associated symptom in the current week. The occurrence of symptoms decreased with an increase in age in both genders (p<0.05). About 21.2% (95% CI 13.3% to 29.1%) of women and 7.1% (95% CI 5.4% to 7.8%) of men treated symptoms themselves after symptoms first appeared. Of the women and men with symptoms, 37.4% (95% CI 24.8% to 50.0%) and 46.8% (95% CI 39.7% to 51.4%), respectively, sought care. Most women visited a gynaecologist and midwife; men tended to visit a general practitioner and urologist after their symptoms appeared. CONCLUSIONS: The prevalence of STI-associated symptoms in Iranian adults is considerable. The results emphasise the need for appropriate and timely STI care and more attention to sexual health promotion to mitigate onward and future infections. Attention to the care-seeking pattern is fundamental to policymaking and planning.

Suicide related ideation and behavior among Canadian gay and bisexual men: a syndemic analysis.

BACKGROUND: While several studies have demonstrated that gay and bisexual men are at increased risk of suicide less attention has been given to the processes that generate the inherent inequity with the mainstream population. This study tested whether syndemic theory can explain the excess suicide burden in a sample of Canadian gay and bisexual men. Syndemic theory accounts for co-occurring and mutually reinforcing epidemics suffered by vulnerable groups due to the effects of social marginalization. METHODS: This study used data from Sex Now 2011, a cross-sectional survey of Canadian gay and bisexual men (n = 8382). The analysis measured the extent to which anti-gay marginalization and several psychosocial health problems are associated with suicide related ideation and attempts. Since psychosocial health problems were hypothesized to have an additive effect on suicide related ideation and attempts, the analysis calculated the effect of accumulated psychosocial health problems on suicide behavior. RESULTS: Suicide ideation and attempts were positively associated with each individual marginalization indicator (verbal violence, physical violence, bullying, sexual violence and work discrimination) and psychosocial health problems (smoking, party drugs, depression, anxiety, STIs, HIV risk and HIV). Furthermore, prevalence of suicide ideation and attempts increased with each added psychosocial health problem. Those who reported 3 or more had 6.90 (5.47-8.70) times the odds of experiencing suicide ideation and 16.29 (9.82-27.02) times the odds of a suicide attempt compared to those with no psychosocial health problems. CONCLUSIONS: This investigation suggests that syndemics is a useful theory for studying suicide behavior among gay and bisexual men. Moreover, the findings highlight a need to address gay and bisexual men's health problems holistically and the urgent need to reduce this population's experience with marginalization and violence.

Psychiatric-mental health nurses and the sex trafficking pandemic.

Nurses are in a unique position to treat survivors of human trafficking and are most likely to encounter patients who have been involved in the sex trade. In particular, psychiatric-mental health nurses can be effective because they are educated to think of clients holistically and can provide both short-term medical intervention and long-term psychotherapy. Additionally, they can recognize and refer these individuals for medical treatment. The purpose of this article is to present an overview of sex trafficking and what psychiatric-mental health nurses can do to treat survivors.

Exploring sexual health among female sexually transmitted disease clinic patients, San Francisco 2010.

BACKGROUND: Current data on sexual health in the United States is limited, in part, because of a lack of measurement tools. It is difficult for programs to develop a holistic approach to improving sexual health that is data-driven and evaluable without a tool that encompasses sexual health beyond the absence of disease. The objective of this study was to understand possible factors associated with sexual health and reported differences in sexual health among women. METHODS: We conducted a survey measuring sexual health among women seeking care at the municipal sexually transmitted disease (STD) clinic in San Francisco between January 25, 2010, and June 15, 2010. Records were matched on variables including basic demographics, reason for visit, symptoms at visit, history of an STD, and STD diagnosis at the visit. RESULTS: A total of 822 women completed the questionnaire during the study period. Women reporting no recent sexual activity reported feeling more insecure, angry, isolated, and limited because of health compared with women with recent sexual activity. However, few differences were seen among women based on symptoms and diagnosis at visit. DISCUSSION: Given the minimal differences based on symptoms and disease, this suggests that there are other factors that impact the quality of life and sexual health. Creating tools that can be used to measure sexual health is a necessary first step for programs to understand the sexual health of a community. More broad-based assessments of sexual health in a variety of populations will be critical to identifying points of intervention and progress toward success.

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.

Exploring knowledge and healthseeking behaviour related to sexually transmitted infections among the tribal population of Madhya Pradesh, central India.

This community-based cross-sectional study was carried out in the tribal population of randomly selected villages of Jabalpur district, Madhya Pradesh, central India. A total of 200 married men and women aged 15­49 years were interviewed to explore their knowledge, experience and health-seeking behaviour related to sexually transmitted infections (STIs). Though 91% of respondents were aware of STIs, the sexual route was mentioned by only 19%as the route of transmission. Around 18% reported a need for social isolation from persons with STIs. Though 88% of the respondents felt modern medicine was the best remedy for STIs, only a few of them used medical treatment while suffering from an STI. Twenty-seven per cent of respondents resorted to traditional healers, and 30% utilized home remedies for STI treatment. The study highlights a need for generating STI awareness amongst the tribal population of the region through a needs-based behaviour change communication (BCC)strategy.

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.

The impact of discussing a sexual history in role-play simulation teaching on pre-clinical student attitudes towards people who submit for STI testing.

Sex, sexuality and sexual health beliefs are individual, impacting on physical and mental health. Sexual history taking is rarely taught in General Practice (GP). However, 'sex' is routinely relevant in this setting. Birmingham students practice discussing sexual history with a simulated-patient in GP. Simulated-patient inclusion in teaching/assessment is well-documented, but no study evaluating the impact of role play on attitudes to people who need STI testing was identified. We aimed to identify whether facilitated simulations featuring a sexual history scenario effected change in students' attitudes towards people who need STI testing. A randomised-controlled-trial was used to compare attitudinal scores between students exposed to an STI role play and a control group who did not receive the role-play teaching until after data capture. There were no significant differences in attitude, either in negative or positive direction, observed between control and intervention groups. Ethnicity was a significant variable, with white-British students self-reporting more positive attitudes. Twenty five percent students admitted personal STI exposure. Again response varied significantly between ethnic groups (the white-British group reporting 4× the exposure). Females reported more positive attitudes than males, most marked in relation to 'willingness to date' someone who admitted to STI testing.

A controlled study of an HIV/AIDS/STI/TB intervention with faith healers in Vhembe District, South Africa.

The aim of the study was to develop an HIV and AIDS training manual, and to evaluate the knowledge, attitudes and management of faith healers of Apostolic churches regarding HIV and AIDS, before and after they attended an HIV and AIDS training programme. A quasi-experimental intervention design was used with faith healers affiliated with the United African Apostolic Church (UAAC) in the Thulamela and Musina municipalities of Vhembe District, Limpopo Province, South Africa. A total of 103 faith healers were included in this study, 58 were systematically assigned to an intervention and 45 to a control group. The intervention group received training for 2 days. At follow-up after 2 months, intervention effects were significant for HIV knowledge and to a lesser extent TB knowledge. No significant improvement was found in HIV/STI (sexually transmitted infection) management strategies such as HIV/STI risk behaviour counselling, referral of clients for HIV testing, keeping condoms at stock in church, and church community HIV/AIDS/STI education. It is important to note that faith healers address some of the major known behavioural risk and protective factors such as partner reduction and condom use. Therefore, faith healers could be more widely utilized in HIV prevention programmes as risk reduction counsellors, in particular on matters of community-level education.

Self-disclosure of sexually transmitted diseases: an integrative review.

In the United States, there are currently more than 65 million individuals living with a sexually transmitted disease (STD), and approximately 19 million new infections will continue to occur each year. To decrease the transmission of potentially dangerous and life-altering STDs, self-disclosure of sexual and drug history and sexual orientation is paramount. This integrative review examines the concept of self-disclosure of STDs, suggests areas of additional research, and proposes a comprehensive public health campaign, with a specific focus on the recent human papillomavirus epidemic to improve the physical and psychological health of all individuals.

Condom use, contraceptive methods, and religiosity among youths of low socioeconomic level.

The purpose of this study was to investigate the relationship between the use of condoms and other contraceptive methods and religiosity/spirituality among youths of a low socioeconomic level in Porto Alegre. 1013 youths, between 12-24 years of age participated, responding to a personal questionnaire containing 109 items. Results show that 53.5% of these youths had already had their first sexual encounter, 55% of which had this experience before the age of 15. The majority (42.8%) claimed to be Catholic, and 26.7% said they believe in God, but were not religious. There appeared no significant difference in the use of condoms in relation to the level of religiosity, however, men used this method more than women to avoid AIDS and as a contraceptive. Women used other contraceptive methods more frequently, and there were no cases of exclusive use of methods permitted by the major religions (natural methods). This study revealed a high level of condom use (more than 80%) among both religious and non-religious youths.