Horse owners' attitudes towards and motivators for using complementary and alternative veterinary medicine.

BACKGROUND: Complementary and alternative veterinary medicine (CAVM) is becoming increasingly popular in horses. METHODS: Online, cross-sectional survey in 1532 horse owners. Attitude towards CAVM, subjective norms, perceived behavioural control and intention for future CAVM use were measured based on the theory of planned behaviour. Structural equation modelling was performed to characterize factors influencing intention to use CAVM. RESULTS: Past use of CAVM, predominantly manual therapies and herbal supplements, was reported by 72.5% of all participants. Frequently reported indications were improving horse's well-being, illness which did not resolve after conventional treatment and chronic illness. The attitude towards CAVM was positive with a median (interquartile range) score of 6 of 7 (4.75-7.00). Predictors for past CAVM use were higher owner age, alternative medicine self-use and higher education (non-university). The strongest predictor of future CAVM usage was perceived behavioural control and perceived CAVM efficacy, as well as positive attitude towards and perceived knowledge about CAVM. The veterinarian was reported as a source of information about CAVM by 86.4% of all participants. CONCLUSIONS: Horse owners showed a high intention to use CAVM with the owners' perceived behavioural control and perceived CAVM efficacy as the strongest predictor. Veterinarian-client communication is important to inform horse owners correctly.

Adolescent boys with autism spectrum disorder growing up: follow-up of self-reported sexual experience.

Systematic research on sexual development in adolescents with autism spectrum disorder (ASD) remains scant, notwithstanding the often-suggested relation between ASD, atypical, and even sexually offensive behaviours. This study compared follow-up data related to lifetime sexual experience (LTSE) in a homogeneous group of adolescent boys with ASD (n = 30), aged 16-20, with a matched group of boys in the general population (n = 60). Most boys in the ASD and control groups reported masturbation and having experienced an orgasm. The proportion of boys with ASD that had no partnered sexual experience was larger than in the control group. This difference was mostly explained by significantly fewer boys with ASD, compared with controls, who reported experience with kissing and petting; no significant differences emerged relating to more intimate partnered sexual experiences. The results suggest the existence of a subgroup of boys who have not (yet) entered the arena of partnered sexual experiences-a finding in line with research in adult samples. There were no differences relating to sexual abuse or coercion. Exploration of the partnered experiences revealed a variety of types of partners, mostly of comparable age. Several boys with ASD had not anticipated their sexual debut. Although they felt ready for it, some boys reported regret afterward. The hypothesised sexual developmental trajectories are subject to further research, but the sexual experience in this sample and the assumed developmental differences indicate the need for early, attuned, and comprehensive sexuality-related education and communication.

Parental Awareness of Sexual Experience in Adolescent Boys With Autism Spectrum Disorder.

Parent report and adolescent self-report data on lifetime sexual experience in adolescents with ASD were compared in 43 parent-adolescent dyads. Parents tended to underestimate the lifetime sexual experience of their sons, particularly solo sexual experiences such as masturbation and experience with orgasm. Parental underestimation and unawareness of adolescents' sexual experience may influence communication and education about sex and sexuality in families. These findings have implications for the interpretation of earlier research, based on parent and caregiver reports, on sexuality in adolescents with ASD.

Outcomes of a systematically designed strategy for the implementation of sex education in Dutch secondary schools.

This study examines the effects of a systematically designed innovation strategy on teachers' implementation of a sex education curriculum and its related determinants. A quasi-experimental group design was used to assess the effectiveness of the innovation strategy. Teachers filled in questionnaires on the determinants of curriculum implementation and kept a record of their actual use of the curriculum. We measured several determinants, including teachers' curriculum-related beliefs, characteristics of the interactive context and characteristics of the innovation strategy. Participating teachers (n=109) carried out most of the activities they were supposed to (81%). Multiple linear regression indicated that their outcome beliefs and perceived instrumentality of the curriculum best predicted extent of use of the curriculum (R2=0.23). The innovation strategy had a positive impact not only on extent of use (18.4 activities versus 15.8 activities; t=2.3, P<0.05), but also on teachers' curriculum-related beliefs. It can be concluded that a systematically designed innovation strategy has the potential to produce significant changes in classroom-based sex-education practices. Not only did teachers exposed to the innovation strategy implement more of the curriculum than teachers in the control group, also teachers' beliefs and expectations about student learning constituting their classroom behavior changed accordingly.

'Menopausal symptoms': associations with menopausal status and psychosocial factors.

This study investigated the relative importance of psychosocial factors as opposed to menopausal status in relation to so-called 'menopausal symptoms' among a large sample of premenopausal, perimenopausal and (naturally and surgically) postmenopausal women (n = 4308) in The Netherlands. The incidence of psychological, somatic, vasomotor and sexual symptoms was assessed and related to menopausal status and to measures relating to coping behaviors, (body- and self-) esteem and quality of life. Among the findings were that vasomotor symptoms in particular, and loss of interest in sex to a lesser extent, were relatively strongly associated with menopausal status. Psychological and somatic symptoms, however, were found to be more closely associated with psychosocial factors (although perimenopausal women as a group were found to suffer them most). Findings are discussed and interpreted as further evidence that only vasomotor symptoms may rightly be called 'menopausal'.

Another decade of social scientific work on sex work: a review of research 1990-2000.

The international, psychological and sociological research literature on prostitution from 1990 through 2000 is reviewed. The stage is set by scanning topics and perspectives in earlier writings. Then the research is discussed under the following headings: (a) HIV related research (HIV prevalence studies, factors in condom use, and prevention program evaluation); (b) workers' background and motivational issues (early victimization and connected factors, economic motives and connected factors); (c) work related issues (working routines, risks and stresses, and managing risk, work and identity); (d) research on clients, and (e) issues related to social and legal status. The literature is still much more about sex than it is about work. In addition, although an increasing number of authors have criticized the dominance of a deviance perspective over work perspectives on prostitution, the literature still reveals many features of stigmatization. For instance, the wrongs associated with sex work are all too often attributed to the nature of sex work itself instead of to the stigma attached to it or to specific negative circumstances. Likewise, the association between prostitution and negative features (in particular HIV and early victimization) is overwhelming, despite evidence that, for large groups of sex workers, these issues are of limited relevance. Generally, writers fail to adequately differentiate among types of sex workers. In particular, in relation to issues of health and well-being, differentiation among sex workers on the basis of specific features of their working situation (e.g., contexts, routines, relations, conditions) has hardly been studied and is recommended for the future.

Condom use by Dutch men with commercial heterosexual contacts: determinants and considerations.

We report responses from 559 clients of female prostitutes, with a view to determining to what extent previously identified factors play a part in condom use. To increase the response rate to advertisements in daily and weekly newspapers, interviews were held by phone. This procedure had the advantage of ensuring the anonymity many clients demanded. Of those clients having vaginal or anal contact (91%), 14% had not always used condoms in the previous year. Compared with consistent condom users, these men were less highly educated, had twice as many commercial contacts, and had more contacts with "steady" prostitutes. They were either more emotionally motivated to visit prostitutes than were consistent condom users or exhibited a stronger need for sexual variation. They showed a more compulsive attitude toward visiting prostitutes, had a more negative attitude toward prostitution in general, evaluated condoms more negatively, had a higher personal efficacy to achieve unsafe contacts, and had a higher general risk assessment, commensurate with their behavior. Men with only safe contacts had either an intrinsic or an extrinsic motivation for condom use. Among extrinsically motivated men, their behavior change was more recent and had not yet taken root: They still envisioned unsafe commercial sex to be possible in the future. Education aimed at the small group of men practicing unsafe contacts will not easily and directly lead to behavior change. But these educational activities may support prostitutes to persist in (consistent) condom use, regardless of clients' pressure to do otherwise.

PIP: The determinants of condom use with commercial sex workers were investigated in the Netherlands in 1993 through phone interviews with 559 male clients who responded to newspaper advertisements for anonymous study respondents. The mean age of respondents was 41 years; 53% were married. Clients had an average of 22 commercial sex contacts in the year preceding the interview. 91% reported vaginal intercourse and 17% anal intercourse. 14% of men in both groups had not used condoms consistently in these encounters. Compared with consistent condom users, the multivariate analysis indicated inconsistent users were less educated, reported twice as many commercial contacts, were more likely to visit steady prostitutes, had a stronger need for sexual variation, viewed condoms more negatively, and considered their risk of HIV infection to be high. The most frequently cited reasons for consistent condom use were fear of infection with HIV (50%) or another sexually transmitted disease (67%) and sex workers' refusal to have unprotected sex (27%). Many clients who reported consistent condom use did not view safer sex as an intrinsic choice, but rather as something forced on them by the prostitute. Given the importance of extrinsic motivation to safer sex practices for HIV prevention, prostitutes must be supported in their insistence on condom use.

Segmentation of heterosexual prostitution into various forms: a barrier to the potential transmission of HIV.

The results of an earlier Dutch study on prostitutes' clients, interviewed face-to-face, were cross-validated by means of telephone interviews, which both guaranteed anonymity and produced a larger sample of respondents (n = 559). Depending on their preference and financial resources, they had visited different types of prostitution; but about half of them had restricted themselves to one type. Inconsistent use of condoms was reported by 14% of the clients who had had vaginal or anal intercourse. Condoms were most frequently used in clubs, brothels and window prostitution, and least often in street, home and escort prostitution; in the last two sorts especially not with regular prostitutes. Whether or not prostitutes came from non-Western countries had no influence on protective behaviour of these clients. The formation of networks between different sorts of prostitution, through unsafe sexual contacts in two or more sorts, involved only 3% of respondents. Thus, prostitution in The Netherlands should be seen as a number of sparsely-connected networks rather than as a single network. The formation of networks between prostitution and the population at large is made possible by the 10% of the respondents who had had unsafe contacts with both commercial and private partners.

Professional HIV risk taking, levels of victimization, and well-being in female prostitutes in The Netherlands.

Professional HIV risk taking (nonconsistent condom use with clients) of female prostitutes in The Netherlands is addressed within the context of (early) experiences with abuse, well-being, coping behavior, job satisfaction, and financial need. Data were gathered from 127 female prostitutes on condom use, financial need, and professional attitude, and on experiences with violence and abuse, physical complaints, psychosocial problems, and coping responses. Violent traumatic experiences were found to relate to more severe complaints and problems, and a higher frequency of emotion-focused coping strategies. A risk-taking protection style (as opposed to consistent condom use and selective risk taking) appeared to be associated with more severe experiences with violence, both in childhood and in adult life, with more frequent dissociation as a coping behavior, and with more psychosomatic complaints. Of all the relationships found, more severe experiences with violence on the job were most strongly related to a higher professional HIV risk.

Alcohol and drug use in heterosexual and homosexual prostitution, and its relation to protection behaviour.

To assess the prevalence and effects of alcohol and drug use in heterosexual and homosexual commercial contacts, and the relationship between their use and unsafe sexual behaviour, 127 female prostitutes, 27 male prostitutes, 91 clients of female prostitutes and 24 clients of male prostitutes were interviewed face-to-face with the help of a semi-structured questionnaire. The respondents were living or working in different parts of The Netherlands. Alcohol and drug use was found to be relatively common among prostitutes. This was also so for the use of alcohol by clients, though to a lesser extent. Prostitutes' consumption varied widely according to the type of prostitution they were employed in. Those meeting their clients in clubs or bars reported the highest consumption of alcohol; hard drugs were used predominantly by street prostitutes. It appears that the main effects of alcohol and drug use are on how the individual experiences working as, or calling on, a prostitute, the social interaction between the two parties, and the sexual contact itself. The common assumption that drinking alcohol has negative effects on condom use was not borne out; though female prostitutes working under the influence of drugs were significantly more likely to report unsafe sex. The degree to which commercial partners were judged to be under the influence of alcohol or drugs was not found to bear upon the frequency of respondents' condom use. For those prostitutes who use hard drugs, this use plays an important role in their engaging in unsafe sexual activities. Prevention activities should focus especially on this group, and should take into account the role of such drug use.

Contextual and interactional factors influencing condom use in heterosexual prostitution contacts.

The protection behavior of prostitutes and prostitutes' clients has been studied from a contextual and an interactional point of view. Different protection styles (subject's cognitive and behavioral position regarding condom use) have been identified in both prostitutes (N = 119) and clients (N = 91). Risk-taking prostitutes were found to have the least favorable working conditions, to have the highest financial need, to have the lowest levels of well-being and job satisfaction and to have been victimized more often than consistent condom users and selective risk-taking prostitutes. Consistent condom users among the clients were found to be better educated, to have a less strong external Health Locus of Control, to evaluate condoms and visiting prostitutes more positively, and prostitutes less negatively, and to have more fear of AIDS than non-consistent condom using clients. Various protection styles were found to be thoroughly intertwined with different interaction scenarios. Four different interaction scenarios (a standard, a romantic, a friendship and a fighting scenario) with a different chance of condom use are set forth. It is shown that the scenario approach gives good insight into the process by which unsafe sex in commercial contacts comes about. For both actors, the context and the meaning of prostitution influence the way they play the game. The interaction and its outcome in their turn reinforce their attitudes towards prostitution. Implications for AIDS prevention are discussed.

Male prostitutes and safe sex: different settings, different risks.

Twenty-seven male prostitutes were interviewed extensively about their work and considerations relating to safe sex with clients. Important differences were found between street prostitutes and those working at home. Street-workers were more likely to be using hard drugs, to have a heterosexual preference, to have no other occupation, to have more clients, but less steady ones, and to have a more negative working attitude. Sexual techniques most often practised were manual and oral contact; however, most prostitutes also practised either insertive or receptive anal intercourse. Homosexual male prostitutes reported more receptive anal intercourse than did their heterosexual male colleagues; but no such differences were found in insertive anal intercourse. Prostitutes were most likely to have had anal intercourse with steady clients, with clients whom they trusted regarding condom use, or with clients they felt sexually attracted to; and also when in dire need of drugs. Of those who had practised anal intercourse in the previous year, a minority had not consistently used condoms. The same factors that encourage anal intercourse also appear conducive to unprotected intercourse.

PIP: 27 male prostitutes were interviewed in the Netherlands over the period July 1990 - January 1991 about their work and considerations relating to safe sex with clients. They were aged 18-40 of mean age 25 years, with 85% working in one of Holland's four largest cities, especially Amsterdam. No non-Dutch prostitutes were recruited. Sixteen worked in street prostitution, nine in home prostitution, and two in clubs or brothels. These latter prostitutes are underrepresented, however, because establishment owners were reluctant to grant permission to interview their boys. Street workers were of mean age 23 years compared to the mean age 29 years of men who worked at home. The prostitutes tended to pass back and forth between club/brothel prostitution and either street or home prostitution, with little interchange between street and home prostitution. All heterosexual street prostitutes used hard drugs, while all non-drug-using street prostitutes considered themselves to be gay or bisexual. The use of hard drugs, gambling habits, curiosity, and/or an interest in easy money prompted their entry into prostitution. Respondents began prostituting themselves at the average age 18 years. Street workers worked an average 26 hours per week with 30 clients at 67 guilders per sexual episode. Home workers, however, worked an average of 7 hours per week with 13 clients at 140 guilders per sexual episode. Street workers spend an average 42 minutes/client compared to the 79 minutes/client among home workers. Of the various types of prostitution, home prostitution corresponds closest to unpaid sex and intimate relationships. Four street workers and four home workers each participated in anal receptive sexual intercourse, while 12 street workers and 7 home workers participated in anal insertive sexual intercourse. 50% did not always use condoms during receptive intercourse, while four street workers and one home worker did not always use condoms during insertive intercourse. In the previous year, 30% of these men reported receptive intercourse and 74% insertive anal intercourse, mostly with low frequency. A reluctance to have anal receptive sex stemmed from their personal dislike of the activity and to some extent fear of HIV infection. Respondents were mainly negative about personally wearing condoms, but they still use them. There was a relatively low rate of condom use in orogenital sex because HIV transmission occurs mainly in anal sex. All were well-informed about which sex practices can definitely cause HIV transmission, although some uncertainty exists whether transmission can occur through oral intercourse or kissing. This study therefore found anal intercourse, especially the receptive form, to not be one of the sexual services which prostitutes in the Netherlands offer clients as a matter of course, and the rate of condom use in such intercourse is high.

[Risky life, risky business: AIDS risk of female prostitutes in the context of early abuse and well-being]. / Risky life, risky business? Aidsrisico van prostituees in het licht van geweldervaringen en welzijn.

PIP: Between July 1990 and March 1991, in the Netherlands, data were gathered by means of a semistructured questionnaire on condom use to assess the AIDS risk faced by 127 female prostitutes within the context of experiences with violence and abuse, well-being, physical and psychosocial problems, coping behavior, professional attitude, and financial need. 92 women had completed data on abuse. About 1 in 20 (4.3%) had experienced abuse both in their youth and adulthood. Only 1 in 5 women (22.8%) had not experienced any abuse, not even in their work. 57% of the respondents had experienced violence of one form or another in their work (physical or sexual violence). 45% of the women escaped abuse in private life (from being forced into prostitution, physical or sexual violence), while about 50% of them also experienced abuse in private life, in most cases associated with their work in prostitution. 48% and 8% of the women, respectively, experienced one or both forms of abuse in their youth and adult private life. The relationship between early experience and violence in private life was significant, as was that between violence in private life and violence in work (p .01). The relationship between violence in private life and complaints as well as coping strategies was less significant. However, there was a significant relationship between problem solving and other variables. Discrimination analysis was based on the Statistical Package for the Social Sciences (SPSS). The strongest relationship was found between violence and protective behavior (condom use in intercourse) and the weakest between violence and age. Financial pressure and attitude to work also carried a relatively strong effect. The mean group values of discrimination functions were 3.29 for risk takers, -.23 for those with consistent protective behavior, and -.87 for women who exercised selective protective behavior.^ieng

Protection styles of prostitutes' clients: intentions, behavior, and considerations in relation to AIDS.

PIP: The perceived costs and benefits of condom use within the context of commercial sex were examined in interviews with 87 clients of female Dutch prostitutes. 8 types of condom users were identified: convinced (46% of the study group), guilty conscience (11%), anti-ridden (13%), defaulting (6%), maximum selective (8%), minimum selective (3%), indifferent (8%), and recalcitrant (5%). Clients who consistently used condoms take responsibility for both the pleasure and safety of their sexual encounter; their attitude toward prostitution is positive and straightforward. Guilty conscience users are motivated to use condoms by feelings of guilt toward their wife and are ambivalent about their participation in commercial sex. Angst-ridden users are motivated to seek out prostitutes more by loneliness than the pursuit of sexual pleasure; they view their personal risk of acquired immunodeficiency syndrome (AIDS) as higher than that reported by consistent users and thus are motivated by fear to use condoms. Defaulting users perceive themselves as the victims of temptation and express a lack of control over the sexual encounter that places them at risk of unprotected sex. Maximum selective users are consistent in using condoms in sex with prostitutes, except when it involves a prostitute whom they see regularly and frequently. Minimum selective users seek frequent contact with prostitutes and base condom use on a subjective assessment of whether the woman is healthy or not. Indifferent users, often disabled and lonely men with no other source of sexual contact, base their condom use or nonuse solely on the wishes of the prostitute. Finally, recalcitrant users are characterized by a desire for power and protest condom use. In general, consistent condom use was related to a positive evaluation of prostitutes, positive attitudes toward the advantages of condom use, an internal locus of control with regard to health, and a higher level of education.^ieng

The effectiveness of condom use in heterosexual prostitution in The Netherlands.

OBJECTIVES: To assess the extent to which condoms are used effectively in commercial heterosexual intercourse. Data on the number of condoms that had broken or slipped off, the sexual technique during which this had occurred and the perceived cause of failure were collected. The use of non-water-soluble lubricants and non-fortified condoms during anal intercourse, and the demand for a greater variety of condom sizes were also examined. SUBJECTS AND METHODS: One hundred and twenty-seven female prostitutes and 91 male clients from different parts of The Netherlands were interviewed face-to-face between July 1990 and March 1991. RESULTS: Of those who used condoms during vaginal intercourse, 49% of the prostitutes had experienced condom breakage in the previous 6 months, and 16% of the clients in the previous 12 months. The breakage rate was 0.8% for prostitutes and 1.5% for clients. Condom quality was seldom reported as the cause; breakage was generally attributed to human factors, such as rough or prolonged intercourse, incorrect handling of the condom or the use of insufficient lubricant. Prostitutes also identified penis size as a cause. Condoms slipping off before or after ejaculation was reported less frequently than breakage. Thirteen per cent of clients and 36% of prostitutes expressed a need for either smaller or larger condoms. Of the prostitutes, 9% used oil or vaseline as a lubricant. CONCLUSIONS: In view of the low rate of condom failure in heterosexual prostitution in The Netherlands, the potential spread of HIV by this means is small. The use of a greater variety of condom sizes may further reduce the failure rate. Few prostitutes remain ignorant about the adverse effects of oil-based lubricants on condoms.

Condom use by prostitutes: behavior, factors and considerations.

PIP: 119 female prostitutes were interviewed over the period July 1990-March 1991 about their sex behavior and condom use, their working attitude, and perception of risk in an attempt to combine qualitative and quantitative research methods to gain insight into the determinants of condom use in prostitution by putting high or low risk taking behavior into context. The participants were recruited from different regions of the Netherlands, of mean age 29.8 years, and had been working in the field for an average 6.8 years. Most of the 28% of participants who did not have Dutch nationality were from Germany or Latin America. Health locus of control and attributions concerning an unpleasant proceeding of client contacts were assessed by means of item lists. Prostitutes were identified as either consistent condom users, selective risk takers, or risk takers. Consistent condom users used condoms on all occasions, selective risk takers used condoms for vaginal sex with all but a few selected clients, and risk takers seeing no possibility of consistently getting clients to use a condom for vaginal sex used condoms the least frequently. 78% were consistent users, 11% were selective risk takers, and 11% were risk takers. Protection behavior was found to be linked to working attitude. Condom use is most likely among women with a moderately positive, yet businesslike, working attitude, and least likely among those with a negative working attitude and when there is no positive identification with the professional group. It appears that health locus of control is of no influence on protection style, but risk takers attribute an unpleasant proceeding of client contacts significantly more to powerlessness and helplessness. The authors conclude that the objective situation of women influences condom use at least as strongly as subjective motivations.^ieng