RESUMO
BACKGROUND: Pharmacy syringe sales are effective structural interventions to reduce bloodborne illnesses in populations, and are legal in all but two states. Yet evidence indicates reduced syringe sales in recent years. This study was designed as a feasibility test of an intervention to promote syringe sales by pharmacies in Arizona. METHODS: A four-month pilot among three Arizona pharmacies measured feasibility and acceptability through monthly surveys to 18 enrolled pharmacy staff members. RESULTS: Pharmacy staff reported increased ease of dispensing syringes across the study. Rankings of syringe dispensing as 'easiest' among 6 measured pharmacy practices increased from 38.9 % at baseline to 50.1 % post intervention module training, and to 83.3 % at pilot conclusion. The majority (72.2 %) of pharmacy staff agreed that intervention materials were easy to use. Over 70 % indicated that the intervention was influential in their "being more open to selling syringes without a prescription to someone who might use them for illicit drug use," and 61.1 % reported that in the future, they were highly likely to dispense syringes to customers who would use them to inject drugs. A vast majority (92 %) reported being likely to dispense subsidized naloxone if available to their pharmacy at no cost. CONCLUSIONS: An education-based intervention was found to be feasible and acceptable to pharmacy staff and had an observed impact on perceptions of ease and likelihood of dispensing syringes without a prescription to people who may use them to inject drugs.
Assuntos
Seringas , Humanos , Seringas/provisão & distribuição , Arizona , Projetos Piloto , Farmácias/estatística & dados numéricos , Estudos de Viabilidade , Patógenos Transmitidos pelo Sangue , Serviços Comunitários de Farmácia , Comércio , Farmacêuticos , Antagonistas de Entorpecentes/uso terapêutico , Antagonistas de Entorpecentes/provisão & distribuição , Antagonistas de Entorpecentes/administração & dosagem , Naloxona/provisão & distribuição , Naloxona/uso terapêutico , Naloxona/administração & dosagemRESUMO
We aimed to determine whether the type of outcome expectation, stemming from HPV vaccination, would have any effect on young men's HPV vaccine intent. We recruited young men (18-24 years of age) from two university campuses (n = 150). After answering a series of questions they were randomly assigned to one of three information conditions (all delivered by computer): (1) how women may benefit from men's HPV vaccination, (2) preventing genital warts and (3) preventing head and neck cancers. Intent to be vaccinated against HPV in the next 12 months was assessed before and after receiving the informational session corresponding to the assigned condition. A repeated-measures t-test indicated that a significant increase in young men's intent to be vaccinated after they received the assigned information (t = 9.48, [147], P = 0.0001). However, the increase in intent to be vaccinated did not vary by group assignment as there were no significant differences in mean intent scores between the three groups (F = 0.59, [2/144], P = 0.56). Information that promotes the outcome expectations of protecting women from cervical cancer, preventing genital warts for men and preventing head and neck cancers for men may be equally effective in promoting increased intent for HPV vaccine acceptance among young university men.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/métodos , Vacinas contra Papillomavirus/administração & dosagem , Aceitação pelo Paciente de Cuidados de Saúde , Adolescente , Análise de Variância , Condiloma Acuminado/prevenção & controle , Condiloma Acuminado/psicologia , Feminino , Neoplasias de Cabeça e Pescoço/prevenção & controle , Neoplasias de Cabeça e Pescoço/psicologia , Educação em Saúde , Vacina Quadrivalente Recombinante contra HPV tipos 6, 11, 16, 18 , Humanos , Masculino , Fatores Sexuais , Neoplasias do Colo do Útero/prevenção & controle , Adulto JovemRESUMO
Condom use errors and problems were compared for anal and vaginal intercourse among a convenience sample of heterosexual men aged 18-66 years (n = 757). Men completed an online questionnaire for the last male condom use event for penile-anal (10.4%) or penile-vaginal (89.6%) intercourse. The prevalence of condom use errors and problems was similar regardless of intercourse type with a few exceptions; those reporting anal intercourse were significantly more likely to report using water-based (P < 0.001) and oil-based (P = 0.037) lubricant and to remove condoms before sex was finished (P < 0.001). The large majority of the sample (93.8%) reported at least one of the nine errors assessed and almost half (46.2%) reported at least one of the seven problems, indicating that many adults may need assistance with these issues. Condom use promotion programmes designed for heterosexual adults are needed that address condom use errors and problems for penile-anal as well as penile-vaginal intercourse.
Assuntos
Preservativos/estatística & dados numéricos , Falha de Equipamento/estatística & dados numéricos , Heterossexualidade , Comportamento Sexual/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , Humanos , Lubrificação , Masculino , Pessoa de Meia-Idade , Parceiros Sexuais , Inquéritos e Questionários , Adulto JovemRESUMO
This study determined whether bisexual male injecting drug users (IDUs) as compared with heterosexual IDUs were more likely to engage in HIV-associated risk behaviours. Respondent-driven sampling was employed to recruit a sample of 382 male IDUs residing in the southeastern USA. Data were collected in face-to-face interviews. Weighted analyses showed that bisexual IDUs in the past 12 months were 4.6 times as likely to share needles and 3.5 times as likely to share a cooker; having multiple female sexual partners and trading money or drugs for sex with women were marginally significant. Bisexual IDUs were 10 times as likely to self-report HIV. Male IDUs, who engage in bisexual behaviour, are also engaging in HIV-associated drug and to some degree sexual-risk behaviours with women more so than heterosexual IDUs. Their higher prevalence of HIV infection coupled with their risk behaviours place themselves and other IDUs at heightened risk of both acquiring and transmitting HIV.
Assuntos
Bissexualidade , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Idoso , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Assunção de Riscos , Sudeste dos Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: To identify associations between men's self-reports of ill-fitting condoms and selected condom use problems, using an event-specific analysis. METHODS: A convenience sample of men was recruited via advertisements in newspapers (two urban and one small town) and a blog on the website of a condom sales company. Men completed a questionnaire posted on the website of The Kinsey Institute for Research in Sex, Gender, and Reproduction. Inclusion criteria were: at least 18 years old, used condoms for penile-vaginal intercourse in the past 3 months and the ability to read English. RESULTS: In controlled, event-specific, analyses of 436 men, those reporting ill-fitting condoms (44.7%) were significantly more likely to report breakage (adjusted odds ratio (AOR 2.6), slippage (AOR 2.7), difficulty reaching orgasm, both for their female partners (AOR 1.9) and for themselves (AOR 2.3). In addition, they were more likely to report irritation of the penis (AOR 5.0) and reduced sexual pleasure, both for their female partner (AOR 1.6) and for themselves (AOR 2.4). Furthermore, they were more likely to report that condoms interfered with erection (AOR 2.0), caused erection loss (AOR 2.3), or became dry during sex (AOR 1.9). Finally, they were more likely to report removing condoms before penile-vaginal sex ended (AOR 2.0). CONCLUSIONS: Men and their female sex partners may benefit from public health efforts designed to promote the improved fit of condoms.
Assuntos
Preservativos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Preservativos/efeitos adversos , Comportamento do Consumidor , Desenho de Equipamento , Falha de Equipamento , Disfunção Erétil/etiologia , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Orgasmo , Inquéritos e Questionários , Adulto JovemRESUMO
STUDY OBJECTIVE: To evaluate an intervention to reduce HIV/STD-associated behaviors and enhance psychosocial mediators for pregnant African-American adolescents. DESIGN: A randomized controlled trial. Participants completed baseline and follow-up assessments. SETTING: An urban public hospital in the Southeastern U.S. PARTICIPANTS: Pregnant African-American adolescents (N=170), 14-20 years of age, attending a prenatal clinic. INTERVENTION: Intervention participants received two 4-hr group sessions enhancing self-concept and self-worth, HIV/STD prevention skills, and safer sex practices. Participants in the comparison condition received a 2-hr session on healthy nutrition. MAIN OUTCOME MEASURES: Consistent condom use. RESULTS: Intervention participants reported greater condom use at last intercourse (adjusted odds ratio=3.9, P=0.05) and consistent condom use (AOR=7.9, P=0.05), higher sexual communication frequency, enhanced ethnic pride, higher self-efficacy to refuse risky sex, and were less likely to fear abandonment as a result of negotiating safer sex. CONCLUSIONS: Interventions for pregnant African-American adolescents can enhance condom use and psychosocial mediators.
Assuntos
Negro ou Afro-Americano , Preservativos/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Cuidado Pré-Natal/métodos , Comportamento de Redução do Risco , Infecções Sexualmente Transmissíveis/prevenção & controle , Adolescente , Feminino , Infecções por HIV/etnologia , Promoção da Saúde , Humanos , Negociação , Educação de Pacientes como Assunto , Gravidez , Sexo Seguro , Autoimagem , Infecções Sexualmente Transmissíveis/etnologia , População Urbana , Adulto JovemRESUMO
OBJECTIVES: To identify (1) the prevalence of condom breakage, and demographic and sexuality-related differences among young men who have sex with women reporting and not reporting this event; (2) condom-specific behaviours associated with breakage. METHODS: Young men (n = 278) attending a clinic for treatment of sexually transmitted infections (STIs) responded to an anonymous questionnaire aided by a CD recording of the questions. The samples were screened to include only men who had used a condom during penile-vaginal sex at least three times in the past 3 months. Condom-specific behaviours (including breakage) were assessed using these last three acts of condom use as the recall period. Correlates achieving bivariate significance were subjected to multivariate analysis. RESULTS: Nearly one third (31.3%) of the men reported recent breakage. The breakage rate was 15%. Three correlates significantly distinguished between men who did and did not report breakage. Men who had past STIs were more likely to report breakage (adjusted odds ratio (AOR) 2.08), as were men who also reported condom slippage (AOR 2.72). Less self-efficacy for correct condom use was also significantly associated with breakage (AOR 1.07). Further, three condom-specific behaviours were significantly associated with breakage: allowing condoms to contact sharp objects (AOR 2.6), experiencing problems with the "fit or feel" of condoms (AOR 2.3) and not squeezing air from the receptacle tip (AOR 2.0). CONCLUSIONS: Breakage may be common and may occur in a larger context of difficulties with condoms. STI clinics could potentially benefit some men by providing instructions on the correct use of condoms.
Assuntos
Preservativos/estatística & dados numéricos , Comportamento Sexual , Adulto , Preservativos/normas , Falha de Equipamento , Etnicidade , Humanos , Masculino , Análise de Regressão , Autoeficácia , Saúde da População UrbanaRESUMO
OBJECTIVE: To determine prospectively the relation between sexually transmitted infection (STI) diagnosis and depressive symptomatology. METHODS: Secondary data analyses were performed on 175 sexually active African-American female adolescents, who were recruited from high risk neighbourhoods in Birmingham, Alabama, United States. RESULTS: ANCOVA was used to compare adolescents who tested positive with adolescents who tested negative on three waves of depressive symptom scores, controlling for age. The STI positive group had higher depressive symptom levels at 6 months relative to the STI negative group. This result was moderated by baseline depressive symptom levels: for adolescents above the clinical threshold, the STI negative group experienced a decrease in symptoms at 6 months whereas the STI positive group maintained the same level. For adolescents below the clinical threshold, there were no changes in depressive symptom levels regardless of diagnosis. CONCLUSIONS: Receiving an STI diagnosis may affect depressive symptomatology for those at risk for depression. Screening for depression in settings that provide STI testing and treatment may be warranted for this population.
Assuntos
Negro ou Afro-Americano , Transtorno Depressivo/etiologia , Infecções Sexualmente Transmissíveis/psicologia , Adolescente , Análise de Variância , Transtorno Depressivo/etnologia , Feminino , Humanos , Estudos Longitudinais , Análise Multivariada , Fatores de Risco , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/etnologia , Estados Unidos/etnologiaRESUMO
BACKGROUND/OBJECTIVES: Herpes simplex virus type 2 (HSV-2) is a common infection among HIV infected people. HSV type specific serologies permit the diagnosis of previously unrecognised HSV-2 infection. While substantial psychosocial morbidity has been associated with a clinical diagnosis of genital herpes, the burden associated with a serological diagnosis of HSV-2 is unclear. This study prospectively measured the psychosocial response to a new serological HSV-2 diagnosis in patients receiving care at an urban HIV clinic. METHODS: At entry, sera were tested for HSV-1 and HSV-2 antibodies by western blot. Participants completed a 90 item psychosocial and life quality questionnaire at enrollment, and at 2 weeks, 3 months, and 6 months after receiving test results. RESULTS: Of 248 HIV infected participants, 172 (69.4%) were HSV-2 seropositive and 116 (67.4%) seropositive people did not have a previous history of genital herpes. After correction for multiple comparisons, no statistically significant differences were detected on the psychosocial and life quality scales between those who received a new HSV-2 serological diagnosis compared with those who were HSV-2 seropositive with a history of genital herpes, or those who tested HSV-2 seronegative. Additionally, no significant changes in scores were observed during follow up. CONCLUSIONS: HSV-2 was a common but often unrecognised infection in this urban HIV clinic and participants coped well with a positive HSV-2 result. Concerns about psychosocial burden should not deter serological testing for HSV-2. Given the epidemiological and clinical interaction between HSV-2 and HIV, these data support routine HSV-2 testing of HIV infected people.
Assuntos
Infecções por HIV/complicações , Herpes Simples/psicologia , Herpesvirus Humano 2 , Adaptação Psicológica , Adulto , Afeto , Assistência Ambulatorial , Atitude Frente a Saúde , Western Blotting , Feminino , Herpes Simples/complicações , Herpes Simples/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Qualidade de Vida , Comportamento Sexual , Saúde da População UrbanaRESUMO
The sexually transmitted infection (STI) epidemic among adolescents in the USA is inextricably tied to individual, psychosocial and cultural phenomena. Reconceptualizing the epidemic within an expanded socio-ecological framework may provide an opportunity to better confront its challenges. In this article, we use a socio-ecological framework to identify determinants of adolescents' sexual risk and protective behaviours as well as antecedents of their STI acquisition. The goal is to provide a synthesis of several discrete categories of research. Subsequently, we propose an integrated strategy that addresses the STI epidemic among adolescents by promoting a socio-ecological perspective in both basic research and intervention design. This approach may expand the knowledge base and facilitate the development of a broader array of intervention strategies, such as community-level interventions, policy initiatives, institutionally based programmes, and macro-level societal changes. Although there are inherent challenges associated with such an approach, the end result may have reciprocal and reinforcing effects designed to enhance the adoption and maintenance of STI-preventive practices among adolescents, and further reduce the rate of STIs.
Assuntos
Comportamento do Adolescente/psicologia , Comportamento Sexual/psicologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Meio Social , Sociologia Médica , Adolescente , Adulto , Ecologia , Feminino , Humanos , Masculino , Relações Pais-Filho , Grupo Associado , Fatores de Risco , Assunção de Riscos , Estados UnidosRESUMO
Self-reported condom use is a key variable in surveys of sexual behavior and in studies evaluating interventions to reduce the risk of sexually transmitted infections. This article provides a review of how male condom use has been assessed in research. We critically review a number of methodological issues, including the length of the recall period, terminology, specification of partner variables, validity and reliability of condom use, and use of newer data collection methods such as daily diaries and computer-assisted and online technologies. Assessment of condom use errors and problems, and the role of women in condom use are discussed. Finally, we offer recommendations for improving assessment of condom use in future research.
Assuntos
Nível de Alerta , Coito , Preservativos/estatística & dados numéricos , Satisfação Pessoal , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/prevenção & controle , Feminino , Humanos , Masculino , Projetos de Pesquisa , Educação Sexual , Infecções Sexualmente Transmissíveis/transmissão , Condições SociaisRESUMO
OBJECTIVE: To extend the current knowledge base pertaining to condom failure among young African-American men by assessing their experiences with male condom use. METHODS: Qualitative assessments were conducted with 19 African-American men (aged 18-29 years) who had just been diagnosed with an STI and reported using condoms in the previous 3 months. RESULTS: Five categories were identified from the data. These categories pertained to: (1) the "fit and feel" of condoms; (2) condom brand and size; (3) application problems; (4) availability of condoms and lubricants; and (5) commitment to condom use. Common themes included reasons why men believed condoms would break or slip off during sex. Comfort problems, including tightly fitting condoms and condoms drying out during intercourse, were mentioned frequently. Condom associated erection problems were often described. Many men also noted that condom use reduced the level of sexual satisfaction for their female partners. Men noted that finding the right kind of condom was not always easy and it became apparent during the interviews that men typically did not acquire lubrication to add to condoms. Despite their expressed problems with using condoms, men were, none the less, typically emphatic that condom use is an important part of their protective behaviour against STIs. CONCLUSION: Men were highly motivated to use condoms; however, they experienced a broad range of problems with condom use. With the exception of losing the sensation of skin to skin contact, the vast majority of these problems may be amenable to behavioural interventions.
Assuntos
Atitude Frente a Saúde/etnologia , Negro ou Afro-Americano/psicologia , Preservativos/normas , Comportamento Sexual/psicologia , Adolescente , Adulto , Conscientização , Preservativos/estatística & dados numéricos , Falha de Equipamento , Humanos , Kentucky , Masculino , Comportamento Sexual/etnologiaRESUMO
BACKGROUND: Social capital has been related to a number of important public health variables such as child welfare, mortality, and health status. However, the relation of social capital to infectious diseases has received relatively little attention. The relation of social capital to health measures is often posited to be related to the key societal variables of poverty and income inequality. Therefore, any exploration of the correlation between social capital and infectious diseases should also include examination of the association with poverty and income inequality. OBJECTIVE: This study examined the state level association between social capital, poverty, income inequality, and four infectious diseases that have important public health implications given their long term sequelae: gonorrhoea, syphilis, chlamydia, and AIDS. METHOD: A state level, correlational analysis (including bivariate linear correlational analysis, and multivariate linear stepwise regression analysis) was carried out. 1999 state level rates of gonorrhoea, syphilis, chlamydia, and AIDS were the main outcome measures. RESULTS: In bivariate analyses, poverty was significantly correlated with chlamydia; income inequality was significantly correlated with chlamydia and AIDS case rates; and social capital was significantly correlated with all outcome measures. In stepwise multiple regression analyses, social capital was always the strongest predictor variable. CONCLUSIONS: These results suggest that social capital is highly predictive of at least some infectious diseases. The results indicate the need for further research into this relation, and suggest the potential need for structural interventions designed to increase social capital in communities.
Assuntos
Renda/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/epidemiologia , Síndrome da Imunodeficiência Adquirida/epidemiologia , Gastos de Capital , Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Humanos , Áreas de Pobreza , Análise de Regressão , Sífilis/epidemiologia , Estados Unidos/epidemiologiaRESUMO
The risk of acquiring sexually transmitted diseases (STDs) and HIV infection is one of the most significant and immediate risks to the health and well being of adolescents. One promising strategy to protect adolescents from STD/HIV infection is to promote parental monitoring. In this article, we first review selected observational studies that provide evidence supporting the value of parental monitoring in reducing adolescents' risk of STD/HIV acquisition. Subsequently, we discuss the potential implications of the research in regards to clinic- and community-based STD/HIV prevention programs for adolescents.
Assuntos
Síndrome da Imunodeficiência Adquirida/prevenção & controle , Soropositividade para HIV/transmissão , Poder Familiar , Infecções Sexualmente Transmissíveis/prevenção & controle , Adolescente , Feminino , Humanos , Masculino , Relações Pais-Filho , Comportamento Sexual/psicologiaAssuntos
Negro ou Afro-Americano/psicologia , Relações Interpessoais , Organizações/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/prevenção & controle , Adolescente , Negro ou Afro-Americano/estatística & dados numéricos , Alabama , Feminino , Seguimentos , Infecções por HIV/prevenção & controle , Humanos , Estudos Prospectivos , Assunção de Riscos , Comportamento SexualRESUMO
OBJECTIVE: The purpose of the study was to examine the association between adolescents' psychological distress and their sexually transmitted disease/human immunodeficiency virus (STD/HIV)-associated sexual behaviors and attitudes. METHOD: Sexually active black adolescent females (N = 522) completed, at baseline and again 6 months later, a self-administered questionnaire that assessed sexual health attitudes and emotional distress symptoms (using standardized measures, alpha =.84), a structured interview that assessed STD/HIV-associated sexual risk behaviors, and a urine screen for pregnancy. RESULTS: In multivariate analyses, controlling for observed covariates, adolescents with significant distress at baseline were more likely than their peers, after 6 months, to be pregnant (adjusted odds ratio [AOR]: = 2.0), have had unprotected vaginal sex (AOR = 2.1), have nonmonogamous sex partners (AOR = 1.7), and not use any form of contraception (AOR = 1.5). Additionally, they were also more likely to: perceive barriers to condom use (AOR = 2.2), be fearful of the adverse consequences of negotiating condom use (AOR = 2.0), perceive less control in their relationship (AOR = 2.0), have experienced dating violence (AOR = 2.4), feel less efficacious in negotiating condom use with a new sex partner (AOR = 1.6), and have norms nonsupportive of a healthy sexual relationship (AOR = 1.7). DISCUSSION: The findings suggest that psychological distress is predictive over a 6-month period of a spectrum of STD/HIV-associated sexual behaviors and high-risk attitudes. Brief screening to detect distress or depressive symptoms among adolescent females can alert the clinician to the need to conduct a sexual health history, initiate STD/HIV-preventive counseling, and refer for comprehensive psychological assessment and appropriate treatment. Among adolescents receiving STD treatment, those with even moderate emotional distress may be at heightened risk for further unhealthy outcomes. STD/HIV interventions should also consider psychological distress as one potential risk factor that may impact program efficacy.
Assuntos
Negro ou Afro-Americano/psicologia , Transtorno Depressivo/diagnóstico , Assunção de Riscos , Comportamento Sexual , Adolescente , Análise de Variância , Preservativos/estatística & dados numéricos , Comportamento Contraceptivo/psicologia , Escolaridade , Características da Família , Medo , Feminino , Humanos , Relações Interpessoais , Saúde Mental , Gravidez , Gravidez na Adolescência/psicologia , Estudos Prospectivos , Fatores SocioeconômicosRESUMO
STUDY OBJECTIVE: The purpose of this study was to determine correlates of worry about pregnancy among a high-risk sample of low-income African-American adolescent females. Specifically, we tested the hypothesis that perceived male partner desire for pregnancy and level of sexual communication would be independently associated with adolescent females' worry about becoming pregnant. DESIGN: A survey of sexually active African-American adolescent females, 14-18 years of age. SETTING: Recruitment was conducted in low-income neighborhoods of Birmingham, Alabama, characterized by high rates of unemployment, substance abuse, violence, and teen pregnancy. PARTICIPANTS: Adolescents (N = 522) completed a survey and a face-to-face interview, and provided a urine specimen for pregnancy testing. MAIN OUTCOME MEASURE: Nonpregnant adolescents reporting steady relationships with a male sex partner (over the past 6 months) and indicating no immediate desire to become pregnant were included in the analysis (n = 196). Two questionnaire items assessed level of worry about becoming pregnant. RESULTS: Compared to adolescent females reporting their partner did not desire pregnancy, those perceiving their partner desired pregnancy were nearly three times more likely to experience high worry about becoming pregnant (AOR = 2.85; P =.009). Engaging in sex unprotected by a condom was an equally important correlate of high worry (AOR = 2.84; P =.013). Level of communication between partners about pregnancy prevention was not significant. CONCLUSIONS: Adolescent females may experience high worry about becoming pregnant due to desires of their male partner as well as their recent sexual risk behavior.