Concurrent sexual partnerships and human immunodeficiency virus risk among South African youth.

BACKGROUND: To estimate the prevalence of concurrency (more than 1 sex partner overlapping in time), the attitudes/behaviors of those engaged in concurrency, length of relationship overlap, and the association between concurrency and human immunodeficiency virus (HIV) among South Africans aged 15 to 24 years. METHODS: A cross-sectional, nationally representative, household survey of HIV infection, and sexual attitudes and behaviors was conducted among 11,904 15 to 24 year old South Africans in 2003. Analyses were conducted among sexually experienced youth. RESULTS: Men were more likely to report having concurrent (24.7%) than serial partners (5.7%) in the past 12 months, but concurrency was not associated with HIV. Among women, concurrency and serial monogamy were equally common (4.7%), and concurrency, defined by respondent reports of multiple ongoing partners, was associated with HIV in multivariate analysis (odds ratio, 3.4; 95% confidence interval, 1.8-6.5). Median length of relationship overlap was approximately 4 months for women and 3 months for men. Compared to serial monogamists, concurrents reported less consistent condom use, and female concurrents were more likely to report transactional sex and problems negotiating condoms and refusing intercourse. CONCLUSIONS: Concurrency is a common partnership pattern among those youth with multiple partners, especially men. For women, having concurrent relationships may be associated with relationship power imbalances and less ability to protect against HIV. Given the prevalence and likely significance of concurrency in the spread of HIV throughout a sexual network, our findings underscore the need for prevention efforts targeting fidelity.

Young people's sexual health in South Africa: HIV prevalence and sexual behaviors from a nationally representative household survey.

OBJECTIVES: To determine the prevalence of HIV infection, HIV risk factors, and exposure to national HIV prevention programs, and to identify factors associated with HIV infection among South African youth, aged 15-24 years. DESIGN: A cross-sectional, nationally representative, household survey. METHODS: From March to August 2003 we conducted a national survey of HIV prevalence and sexual behavior among 11 904 15-24 year olds. Multivariable models for HIV infection were restricted to sexually experienced youth. RESULTS: Young women were significantly more likely to be infected with HIV in comparison with young men (15.5 versus 4.8%). Among men, a history of genital ulcers in the past 12 months was associated with HIV infection [adjusted odds ratio (AOR), 1.91; 95% confidence interval (CI), 1.04-3.49) whereas among women a history of unusual vaginal discharge in the past 12 months was associated with HIV infection (AOR, 1.75; 95% CI, 1.26-2.44). Young women with older partners were also at increased risk of HIV infection. Among both men and women, increasing partner numbers and inconsistent condom use were significantly associated with HIV infection. Males and females who reported participation in at least one loveLife program were less likely to be infected with HIV (AOR, 0.60; 95% CI, 0.40-0.89; AOR, 0.61; 95% CI, 0.43-0.85, respectively). CONCLUSION: This survey confirms the high HIV prevalence among young people in South Africa and, in particular, young women's disproportionate risk. Programs for youth must continue to promote partner reduction, consistent condom use and prompt treatment for sexually transmitted infections while also addressing contextual factors that make it difficult for them to implement behavior change.

Physicians' views of interventions to reduce medical errors: does evidence of effectiveness matter?

PURPOSE: Despite widespread public attention and numerous ongoing patient safety initiatives, physicians are skeptical of the most commonly prescribed interventions to reduce medical errors. This study examined the association between the published evidence of effectiveness of interventions to reduce medical errors and physicians' ratings of the effectiveness of those interventions. It further assessed whether academic affiliation was associated with physicians' ratings of effectiveness. METHOD: The authors conducted a literature review seeking evidence of effectiveness of 13 interventions to reduce medical errors. A four-page questionnaire was sent to a random sample of 1,332 U.S. physicians in the spring of 2002. A total of 831 (62%) responded, providing ratings of the perceived effectiveness of these interventions to reduce medical errors. RESULTS: We identified published evidence of effectiveness for six of the 13 interventions. Physicians rated 34% of these and 29% of the interventions without published evidence as "very effective" (p < .01). Physicians with an academic affiliation and those in practice for more years were slightly more likely to rate interventions with published evidence as "very effective." CONCLUSIONS: Physicians' ratings of the effectiveness of interventions to reduce medical errors are only weakly associated with published evidence of effectiveness. More evidence, better dissemination strategies for existing evidence such as inclusion in medical school curriculum or recertification examinations, and a focus on removing barriers to interventions may be needed to engage physicians in moving patient safety interventions into medical practice.

Views of practicing physicians and the public on medical errors.

BACKGROUND: In response to the report by the Institute of Medicine on medical errors, national groups have recommended actions to reduce the occurrence of preventable medical errors. What is not known is the level of support for these proposed changes among practicing physicians and the public. METHODS: We conducted parallel national surveys of 831 practicing physicians, who responded to mailed questionnaires, and 1207 members of the public, who were interviewed by telephone after selection with the use of random-digit dialing. Respondents were asked about the causes of and solutions to the problem of preventable medical errors and, on the basis of a clinical vignette, were asked what the consequences of an error should be. RESULTS: Many physicians (35 percent) and members of the public (42 percent) reported errors in their own or a family member's care, but neither group viewed medical errors as one of the most important problems in health care today. A majority of both groups believed that the number of in-hospital deaths due to preventable errors is lower than that reported by the Institute of Medicine. Physicians and the public disagreed on many of the underlying causes of errors and on effective strategies for reducing errors. Neither group believed that moving patients to high-volume centers would be a very effective strategy. The public and many physicians supported the use of sanctions against individual health professionals perceived as responsible for serious errors. CONCLUSIONS: Though substantial proportions of the public and practicing physicians report that they have had personal experience with medical errors, neither group has the sense of urgency expressed by many national organizations. To advance their agenda, national groups need to convince physicians, in particular, that the current proposals for reducing errors will be very effective.