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1.
Rev Saude Publica ; 54: 41, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32321057

RESUMO

OBJECTIVE: To describe the sexual behavior of freshmen undergraduate students according to demographic, economic, psychosocial and behavioral characteristics, and evaluate the prevalence of risky sexual behavior and its associated factors. METHODS: A cross-sectional study of the census type with undergraduate students over 18 years old of 80 undergraduate courses of the Universidade Federal de Pelotas (UFPel), in Rio Grande do Sul (RS), who entered in the first semester of 2017 and remained enrolled in the second semester. Undergraduate students who reported having had sex were evaluated. We considered as risky sexual behavior having more than one sexual partner within the last three months and not having used condoms in the last sexual intercourse. RESULTS: The prevalence of risky sexual behavior was 9% (95%CI 7.6-10.5). Men presented more risky behavior than women, with a prevalence of 10.8% and 7.5%, respectively. Of the undergraduate students, 45% did not use condoms in the last sexual intercourse, and 24% had two partners or more within three months before the survey. Smartphone applications for sexual purposes were used by 23% of students within three months before the survey. Risky sexual behavior was associated with gender, age at first sexual intercourse, frequency of alcohol consumption, consumption of psychoactive substances before the last sexual intercourse and use of smartphone applications for sexual purposes. CONCLUSION: Although undergraduate students are expected to be an informed population, the prevalence of risky sexual behavior was important, indicating the need to expand public investment in sexual education and awareness actions.


Assuntos
Censos , Comportamentos de Risco à Saúde , Comportamento Sexual/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Brasil/epidemiologia , Coito/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Fatores Sexuais , Comportamento Sexual/psicologia , Parceiros Sexuais/psicologia , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/psicologia , Fatores Socioeconômicos , Estudantes/psicologia , Adulto Jovem
3.
BMC Womens Health ; 19(1): 162, 2019 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842845

RESUMO

BACKGROUND: Although an opportunistic approach of cervical cancer screening strategy had been implemented in Ethiopia, utilization of screening services among women is still low, accounted < 1%. We hypothesize that commercial sex women in Ethiopia faced a number of obstacles in order to access screening services. Identifying the predictors influencing utilizations of the screening services is an essential effort to tailor screening program towards increasing the utilization. METHODS: An unmatched case-control study was implemented with a total sample size of 230 (46 cases and 184 controls). The study was conducted among commercial sex workers who attended confidential clinic opened for sex workers. Simple random sampling was employed. After the data were checked for completeness, consistency and accuracy, it was entered in to Epi nfo version 7 then exported to SPSS for further statistical analysis. Descriptive statistics were used to describe the profile of study participants. Logistic regression was employed to identify the predictors of cervical cancer screening uptake. P < 0.05 was computed to determine the level of statistical significance. RESULTS: Cervical cancer screening utilization was associated with providers' recommendation (AOR = 6.8; 95% CI: 2.3, 9.7), history of sexually transmitted infection (AOR = 6.9; 95% CI: 1.29, 7.2), frequency of facility visit (AOR = 4.8; 95% CI: 1.97, 11.8) and history of vaginal examination (AOR = 0.21; 95% CI: 0.1, 0.68). CONCLUSIONS: The level of cervical cancer screening service utilization was higher among women with history of STI, frequency of facility visit and providers' recommendation. The level of cervical cancer screening service utilization was lower in women with previous vaginal examination.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Profissionais do Sexo/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Adolescente , Adulto , Estudos de Casos e Controles , Estudos Transversais , Detecção Precoce de Câncer/psicologia , Etiópia , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Profissionais do Sexo/psicologia , Doenças Sexualmente Transmissíveis/psicologia , Neoplasias do Colo do Útero/psicologia , Adulto Jovem
4.
Georgian Med News ; (292-293): 32-38, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31560659

RESUMO

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.


Assuntos
Prestação Integrada de Cuidados de Saúde , Infecções por HIV/psicologia , Doenças Sexualmente Transmissíveis/psicologia , Adolescente , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Comportamento Sexual , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Inquéritos e Questionários , Ucrânia , Adulto Jovem
5.
Int J Infect Dis ; 87: 170-176, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31404673

RESUMO

OBJECTIVES: Sex workers (SWs) face an increased burden of sexually transmitted and blood-borne infections, yet little is known regarding hepatitis B virus (HBV) prevention and care. This study was performed to characterize cross-sectional and prospective correlates of HBV vaccination among SWs in Vancouver. METHODS: Questionnaire data were drawn from a community-based cohort of SWs (2010-2017). Multivariable logistic regression was used to examine correlates of lifetime self-reported HBV vaccination. Multivariable generalized estimating equation (GEE) regression was used to assess correlates of recent vaccination. RESULTS: Among 855 participants, 68.3% reported lifetime HBV vaccination. Multivariable logistic regression showed that im/migrants (adjusted odds ratio (AOR) 0.50, 95% confidence interval (CI) 0.32-0.78) had lower odds of vaccination and that those using injection drugs (AOR 1.88, 95% CI 1.27- 2.78) and those who had undergone HIV testing (AOR 1.94, 95% CI 1.14-3.29) had higher odds of vaccination. In the multivariable GEE analysis, HIV seropositivity (AOR 1.93, 95% CI 1.26-2.97) and recent STI testing (AOR 2.95, 95% CI 1.99-4.39) correlated with recent HBV vaccination. CONCLUSIONS: Im/migrant SWs from HBV-endemic settings appear to face gaps in HBV prevention. Evidence-based interventions addressing gaps in voluntary HBV prevention and care are needed, including community-based and culturally safe services. Injection drug use and HIV testing were linked to enhanced vaccination, suggesting that harm reduction and HIV programmes may facilitate linkage to HBV prevention.


Assuntos
Vacinas contra Hepatite B/administração & dosagem , Hepatite B/prevenção & controle , Profissionais do Sexo/estatística & dados numéricos , Adulto , Canadá , Estudos Transversais , Feminino , Infecções por HIV/prevenção & controle , Hepatite B/psicologia , Humanos , Masculino , Estudos Prospectivos , Comportamento Sexual , Doenças Sexualmente Transmissíveis/prevenção & controle , Doenças Sexualmente Transmissíveis/psicologia , Abuso de Substâncias por Via Intravenosa/prevenção & controle , Migrantes/estatística & dados numéricos , Vacinação
6.
Int J Infect Dis ; 87: 128-134, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31404674

RESUMO

OBJECTIVES: HIV-1 heterosexual transmission among individuals on antiretroviral treatment (ART) with undetectable viremia is extremely rare. The aim of this study was to evaluate the risk of sexual HIV-1 transmission and other sexually transmitted infections (STIs) in HIV-1 serodifferent couples while the index partner is on ART. METHODS: HIV transmission was evaluated in 200 HIV-1 heterosexual serodifferent couples in a stable relationship (≥3 months). All HIV-positive individuals had been on ART for ≥3 months and had been followed up for a median preceding time of 4.5 years (range 0.3-16 years) at the HIV couples clinic at Hospital Nossa Senhora da Conceição in Porto Alegre, Brazil. Following written informed consent, participants responded to demographic/behavioral questionnaires. Quantitative PCR for HIV RNA, T-cell subsets, and STI testing (syphilis, herpes, human papillomavirus, gonorrhea, and bacterial vaginosis) were performed. Self-collected vaginal swabs were obtained for quantitative HIV genital viral load testing. RESULTS: Among 200 couples, 70% of index partners were female. Five seroconversions were observed; the HIV infection incidence was 2.5% (95% confidence interval 0.8% to 5.7%). Mean plasma viral load results were higher in HIV transmitters compared to non-transmitters (p=0.02). The presence of STIs was significantly greater in couples who seroconverted (60.0% vs. 13.3%; odds ratio 9.75, 95% confidence interval 1.55-61.2; p=0.023). The duration of undetectable HIV viremia and presence of STIs were associated with HIV transmission. CONCLUSIONS: Undetectable viremia was the main factor associated with non-transmissibility of HIV in this setting.


Assuntos
Infecções por HIV/transmissão , Heterossexualidade/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/transmissão , Adulto , Fármacos Anti-HIV/uso terapêutico , Brasil , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Infecções por HIV/virologia , HIV-1/efeitos dos fármacos , HIV-1/genética , HIV-1/fisiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Razão de Chances , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/psicologia , Carga Viral , Adulto Jovem
8.
BMC Public Health ; 19(1): 992, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340797

RESUMO

BACKGROUND: Chlamydia trachomatis (C. trachomatis) is the most common bacterial sexually transmitted infection in the UK. Recent studies suggest that in addition to the genital tract, C. trachomatis is found in the throat and rectum, suggesting the number of infections is under-reported. There is an urgent need to study the impact of extending diagnosis to include extra-genital samples; however, there is a lack of evidence on the acceptability of asking young women to provide these samples. METHOD: A mixed methods single group feasibility study explored the acceptability of combined genital and extra-genital testing in young women aged 16-25 years consecutively attending a sexual health centre in Edinburgh, Scotland. Young women were asked to complete a self- administered anonymous questionnaire whether they would be willing to give self-taken throat and ano-rectal samples. Interviews with women (n = 20) willing to self-sample were conducted before and after self-sampling, and these explored the underlying reasons behind their decision, and feelings about the tests. RESULTS: Of 500 women recruited to the study, 422 (84.4%) women provided sufficient data for analysis. From completed questionnaires, 86.3% of respondents reported willingness to self-sample from the throat. Willingness of ano-rectal self-sampling was lower (59.1%), particularly in women under 20 (< 20 years: 44.4%; ≥20 years, 68.2%). Willingness of ano-rectal self-sampling was higher in women who had more sexual partners in the last 6 months (0 partners, 48.3%, n = 14, 3 or more partners, 67.4%, n = 60) and in those who have previous experience of a positive test for a sexually transmitted infection (STI) (positive: 64.5%; negative: 57%). Interviewed women suggested that a lack of knowledge of STIs, embarrassment and lack of confidence in the ability to carry out the sampling were barriers towards acceptability. CONCLUSIONS: In this study, self-sampling of throat samples is largely acceptable; however, the acceptability of taking an ano-rectal sample for C. trachomatis testing in young women was lower in younger women. The study suggests further research to investigate the acceptability of extra-genital testing as an addition to routine C. trachomatis testing, and whether this increases detection and prevents infective sequelae for women.


Assuntos
Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Programas de Rastreamento/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adolescente , Adulto , Chlamydia trachomatis , Estudos de Viabilidade , Feminino , Humanos , Programas de Rastreamento/métodos , Escócia , Comportamento Sexual/psicologia , Parceiros Sexuais/psicologia , Doenças Sexualmente Transmissíveis/psicologia , Inquéritos e Questionários , Adulto Jovem
9.
J Prev Med Hyg ; 60(2): E76-E83, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31312736

RESUMO

This study, part of the health promotion program of a high school in Milan (Italy), was aimed at evaluating the impact of training conferences on the awareness of STIs among adolescents aged 16-17. Students attending the 3rd class of a Scientific and Linguistic High School in Milan (Italy) participated in this study in November 2017. All students gave their anonymous answers on a voluntary basis in a pre-test survey, designed by psychologists and infectious diseases specialists, to test their basic knowledge, accuracy, and awareness of STIs. After a two-hour interactive conference, the students were asked to answer the post-test survey. A higher awareness of the spread and the mode of transmission of STIs, of high risk sexual and behavioural practices and prevention methods was observed in the post-test compared to the pre-test. These findings outline both the need for sexual-health communication campaigns targeted at adolescents, who are at great risk of exposure and mostly unaware of STIs other than HIV/AIDS, and the short-term efficacy of a direct approach to the problem, guided by experts in infectious diseases and psychology. A long-term assessment of the effects of training conferences needs to be evaluated.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Serviços de Saúde Escolar , Doenças Sexualmente Transmissíveis/psicologia , Estudantes/psicologia , Adolescente , Feminino , Humanos , Masculino , Doenças Sexualmente Transmissíveis/prevenção & controle , Estudantes/estatística & dados numéricos , Inquéritos e Questionários
10.
J Prev Med Hyg ; 60(2): E84-E92, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31312737

RESUMO

Introduction: STIs are a serious public health problem. Worldwide, 500 million people a year acquire a STI, and young are the most affected. Methods: This study was conducted administering an anonymous questionnaire to 1228 Sicilian students of high school and university. Results: The students had variable understanding of STIs and their complications. The results demonstrate an extreme variability in the knowledge of STIs. Multiple linear regression showed that sexual health knowledge was associated with age and sexual orientation. Conclusions: Our results show that knowledge of STIs is poor and inadequate. This finding can put students at risk of STIs.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Doenças Sexualmente Transmissíveis/psicologia , Estudantes/psicologia , Sexo sem Proteção/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Feminino , Humanos , Itália , Masculino , Instituições Acadêmicas , Comportamento Sexual/psicologia , Comportamento Sexual/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Universidades , Sexo sem Proteção/psicologia , Adulto Jovem
11.
BMC Public Health ; 19(Suppl 4): 639, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196029

RESUMO

BACKGROUND: Previous studies show that there is a changing trend of sexual and reproductive behaviour among youth and this requires more attention and awareness especially on sexually transmitted diseases (STD). This study was carried out to evaluate the knowledge, attitude and practice of sexually transmitted diseases among selected inmates of women shelter homes. METHODS: A cross-sectional study was carried out by involving 60 participants whom aged in between 13 to 25 years old. The questionnaires were developed in 'Bahasa Melayu' and it has been anonymous guided questionnaires. RESULTS: The result showed that the mean age of the participants was 17.9 years old and most of the participants have completed secondary school (91.7%). Overall, the level of knowledge of participants on STDs were classified into three groups; 'high knowledge' (33.3%), 'medium knowledge' (35.0%) and 'low knowledge' (31.7%). The majority have heard of HIV/AIDS (95%) but with respect to other STDs was less well known. Whereas, the mean score for attitude was 23.1 out total 25. Their knowledge level was not influenced by their age (p = 0.61) and socio-economic status (p = 0.85). However, their attitude was influenced by their age (p < 0.05). CONCLUSION: Knowledge on non-HIV STDs is still lacking and risky behaviours have been practiced. Although there were high level of knowledge and attitude among them but their practice on sexuality contradicts it especially on contraceptive use and pre-marital sex.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Doenças Sexualmente Transmissíveis/psicologia , Mulheres/psicologia , Adolescente , Adulto , Comportamento Contraceptivo/psicologia , Estudos Transversais , Feminino , Humanos , Assunção de Riscos , Comportamento Sexual/psicologia , Inquéritos e Questionários , Adulto Jovem
12.
BMC Public Health ; 19(Suppl 1): 604, 2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31138182

RESUMO

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.


Assuntos
Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Saúde Reprodutiva/estatística & dados numéricos , Saúde Sexual/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/psicologia , Adolescente , Grupo com Ancestrais do Continente Africano , Criança , Preservativos/estatística & dados numéricos , Estudos Transversais , Feminino , HIV , Infecções por HIV/prevenção & controle , Comportamentos de Risco à Saúde , Humanos , Modelos Logísticos , Masculino , Gravidez , Autorrelato , Educação Sexual , Doenças Sexualmente Transmissíveis/prevenção & controle , Doenças Sexualmente Transmissíveis/virologia , Inquéritos e Questionários , Uganda , Adulto Jovem
13.
Sex Transm Infect ; 95(6): 412-415, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30996107

RESUMO

OBJECTIVE: Child sexual exploitation (CSE) can be difficult to identify, as there may be few reliable indicators. Although they may be used in decision-making, there is no evidence that STIs are predictors of CSE. We investigated the relationship between STI presentation at sexual health clinics (SHCs) and CSE. METHODS: SHCs with 18 or more children aged 13-15 years old with STI diagnoses in 2012 were identified using the Genitourinary Medicine Clinic Activity Data Set STI Surveillance System. Cases with confirmed bacterial or protozoal STIs were matched by age, gender and clinic with non-STI controls. Lead clinicians were asked to complete an online questionnaire on CSE-related risk factors of cases and controls irrespective of STI presence. Associations between STI outcome and CSE-related risk factors were analysed using conditional logistic regression. RESULTS: Data were provided on 466 children aged 13-15 years old; 414 (89%) were female, 340 (80%) were aged 15, 108 (23%) were aged 14, and 18 (3.9%) were aged 13 years. In matched univariate analysis, an STI diagnosis was significantly associated with 'highly-likely/confirmed' CSE (OR 3.87, p=0.017) and safeguarding concerns (OR 1.94, p=0.022). Evidence of an association between STI diagnosis and 'highly-likely/confirmed' CSE persisted after adjustment for partner numbers and prior clinic attendance (OR 3.85, p=0.053). CONCLUSION: Presentation with bacterial or protozoal STIs in children aged 13-15 years old at SHCs may be considered a potential marker for CSE. It would be prudent to consider CSE, indepth assessment and potential referral for any children under 16 years old presenting with a bacterial or protozoal STI.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Abuso Sexual na Infância/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/epidemiologia , Adolescente , Estudos de Casos e Controles , Abuso Sexual na Infância/diagnóstico , Abuso Sexual na Infância/psicologia , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Saúde Sexual , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/psicologia
14.
J Acquir Immune Defic Syndr ; 81(4): 414-418, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30985558

RESUMO

BACKGROUND: Safety net family planning (FP) clinics provide vital care for women in high HIV-burden areas and may be ideal pre-exposure prophylaxis (PrEP) delivery sites. Yet, many FP providers lack knowledge about PrEP. SETTING: Four safety net FP clinics in Atlanta, Georgia. METHODS: We provided a 1.5-hour PrEP informational training for 28 providers working in these sites. To assess the training's impact on PrEP counseling, we enrolled 500 female patients after training (47% ≤ 28 years; 69% black; 12% Hispanic) and determined their PrEP indication based on CDC guidelines. We conducted a postvisit survey to assess provider counseling and patients' interest in PrEP and acceptance of off-site PrEP referral. RESULTS: From pre-training to post-training, provider PrEP knowledge and confidence to identify women who may benefit from PrEP significantly increased. Only 19% of women knew about PrEP before the visit. Among 376 sexually active women, 29% had risk consistent with PrEP indication. Among PrEP-indicated women, 66% reported the provider discussed PrEP, 29% were interested in taking PrEP, but only 18% accepted off-site PrEP referral. Most (76%) were more willing to take PrEP if provided by the FP clinic. CONCLUSIONS: After a brief PrEP training, most women with HIV-risk indicators received PrEP counseling during their visits. Once counseled, women expressed interest if it were offered at the FP clinic rather than through off-site referral. Findings highlight the potential impact that PrEP capacity building within safety net FP clinics in high HIV-burden areas may have on PrEP scale-up for women.


Assuntos
Serviços de Planejamento Familiar/métodos , Infecções por HIV/prevenção & controle , Profilaxia Pré-Exposição/métodos , Doenças Sexualmente Transmissíveis/prevenção & controle , Adolescente , Adulto , Idoso , Fármacos Anti-HIV/uso terapêutico , Aconselhamento , Transmissão de Doença Infecciosa/prevenção & controle , Grupos Étnicos , Feminino , Georgia , Infecções por HIV/tratamento farmacológico , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/psicologia , Adulto Jovem
15.
Sex Transm Infect ; 95(4): 254-261, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30814165

RESUMO

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.


Assuntos
Transtornos de Ansiedade/psicologia , Transtorno Depressivo/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Doenças Sexualmente Transmissíveis/psicologia , Instituições de Assistência Ambulatorial , Estudos Transversais , Feminino , Humanos , Londres , Masculino , Assunção de Riscos , Fatores Sexuais , Comportamento Sexual , Doenças Sexualmente Transmissíveis/prevenção & controle , Medicina Estatal , Inquéritos e Questionários , Adulto Jovem
16.
AIDS Behav ; 23(4): 835-846, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30737609

RESUMO

Latino immigrants with substance use and mental health problems are at risk for undiagnosed HIV and sexually transmitted infections (STIs). Participants in a randomized control trial were recruited in Boston, USA and Madrid and Barcelona, Spain. Eligibility criteria were Latino self-identification, age 18-70, elevated substance use and mental health symptoms, and not currently in substance or mental health care. A multinomial logistic regression examined predictors of HIV/STI testing decline and lost to follow-up (LTFU) prior to testing compared with acceptance. Of 341 participants, 74% accepted testing, 4% declined, and 22% were LTFU. The odds of LTFU were higher in those with high concern for HIV and those whose main partner had done HIV testing. Age ≥ 35 years, females, higher education, and higher report of discrimination lowered the odds of LTFU. Delivery of HIV/STI testing through community agencies and outreach could overcome barriers to HIV/STI diagnosis in this population of Latinos.Clinical Trial Number: NCT02038855.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Infecções por HIV/diagnóstico , Hispano-Americanos/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Transtornos Mentais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Doenças Sexualmente Transmissíveis/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Adulto , Idoso , Boston/epidemiologia , Feminino , Infecções por HIV/etnologia , Infecções por HIV/psicologia , Humanos , Perda de Seguimento , Masculino , Transtornos Mentais/etnologia , Saúde Mental , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Testes Sorológicos , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/etnologia , Doenças Sexualmente Transmissíveis/psicologia , Espanha/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/etnologia
17.
Ann Epidemiol ; 31: 20-25, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30792064

RESUMO

PURPOSE: Sexual minorities experience significant health disparities across a variety of mental, behavioral, and physical health indicators. Yet, an understanding of the etiology and progression of sexual minority health disparities across the lifespan is limited. METHODS: We used the U.S. National Epidemiologic Survey of Alcohol and Related Conditions III to evaluate the association between sexual minority status and seven past-year health outcomes (alcohol use disorder, tobacco use disorder, drug use disorder, major depressive episode, generalized anxiety disorder, sexually transmitted infection, and cardiovascular conditions). To do this, we used unadjusted and adjusted logistic regression among our study sample (n = 30,999; aged 18-65 years) and time-varying effect models to evaluate how sexual orientation differences in these outcomes vary across adulthood. RESULTS: Relative to heterosexuals, sexual minorities had elevated odds of past-year alcohol use disorder and drug use disorder across all ages (18-65 years) although the magnitude of the disparity varies by age. Sexual minorities were also more likely to experience major depressive episode, generalized anxiety disorder, tobacco use disorder, sexually transmitted infection, and cardiovascular disease, but only at specific ages. CONCLUSIONS: Sexual minority health disparities vary appreciably across the adult lifespan, thus elucidating critical periods for focused prevention efforts.


Assuntos
Fatores Etários , Transtorno Depressivo Maior/epidemiologia , Disparidades nos Níveis de Saúde , Saúde das Minorias , Comportamento Sexual/psicologia , Minorias Sexuais e de Gênero/psicologia , Doenças Sexualmente Transmissíveis/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Idoso , Estudos Transversais , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Minorias Sexuais e de Gênero/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/psicologia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/psicologia , Estados Unidos/epidemiologia , Adulto Jovem
18.
Child Abuse Negl ; 88: 466-477, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30420293

RESUMO

Adolescent sexual health is often reflected through a problem-oriented lens. This serves to reinforce prevailing sexual scripts and cultural images of disenfranchised youth. Very little is known about the support young people in foster care, particularly youth of color, need to stay sexually healthy and safe. This article presents data on the sources and types of sexual socialization experiences that supported African American transitional age youth in foster care to protect against sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). Eighteen African American participants (18 to 21-years old) who reported condom use in two quantitative interviews were selected to participate in a qualitative interview. A mapping exercise and thematic analyses were used to identify the participants' sources of support and sexual socialization experiences. The study's findings indicated the youth had a combination of informal and formal sources that conveyed four types of STI/HIV prevention messages: Effective, Affective, Affinity, & Tangible. The majority of the participants (83%) received all four types of STI/HIV prevention messages from adult, partner and/or peer sources. Sources who motivated the participants the most to protect against STIs/HIV had a strong relationship with the youth and communicated openly about safer sex practices. Results of this study provide implications for future research as well as indications for practice that may be incorporated into training for child welfare practitioners, foster parents, kinship caregivers, and others who encounter youth in foster care.


Assuntos
Afro-Americanos/psicologia , Sexo Seguro , Adolescente , Bem-Estar da Criança , Preservativos/estatística & dados numéricos , Feminino , Cuidados no Lar de Adoção , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Humanos , Masculino , Motivação , Pais , Grupo Associado , Comportamento Sexual/etnologia , Comportamento Sexual/psicologia , Saúde Sexual , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/prevenção & controle , Doenças Sexualmente Transmissíveis/psicologia , Socialização , Adulto Jovem
19.
Ann Epidemiol ; 29: 67-73.e1, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30442564

RESUMO

PURPOSE: Voting may play a critical role in the allocation of social and structural resources to communities, which in turn shapes neighborhood environments, and ultimately, an individual's sexually transmitted infection (STI) risk. We assessed relationships among county-level voter turnout and felony voter disenfranchisement, and STIs. METHODS: This cross-sectional multilevel analysis included 666 women in Alabama, Florida, Georgia, Mississippi, and North Carolina enrolled in the Women's Interagency HIV Study between 2013 and 2015. Having a baseline bacterial STI (chlamydia, gonorrhea, trichomoniasis, or early syphilis) was determined by laboratory testing. We used generalized estimating equations to test relationships between county-level voter turnout in the 2012 general election, county-level percentage of felony disenfranchised voters, and STI prevalence. RESULTS: Eleven percent of participants had an STI. Higher voter turnout corresponded to lower STI prevalence (prevalence ratio = 0.84, 95% confidence interval = 0.73-0.96 per 4 percentage point higher turnout). Greater felony voter disenfranchisement corresponded to higher STI prevalence (prevalence ratio = 1.89, 95% confidence interval = 1.10-3.24 per 4 percentage point higher disenfranchisement). CONCLUSIONS: STI prevalence was inversely associated with voter turnout and positively associated with felony voter disenfranchisement. Research should assess causality and mechanisms through which civic engagement shapes sexual health. Expanding political participation, including eliminating discriminatory voting laws, could influence sexual health.


Assuntos
Direitos Civis , Criminosos/psicologia , Política , Prisioneiros/psicologia , Características de Residência , Doenças Sexualmente Transmissíveis/epidemiologia , Adulto , Criminosos/estatística & dados numéricos , Estudos Transversais , Feminino , Gonorreia/epidemiologia , Humanos , Análise Multinível , Prisioneiros/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/psicologia , Fatores Socioeconômicos , Sífilis/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
20.
J Acquir Immune Defic Syndr ; 80(1): 36-39, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30531295

RESUMO

BACKGROUND: Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV transmission. Cisgender women (cis-women) constitute only a small proportion of PrEP users in the United States despite accounting for 19% of new HIV infections in 2016. SETTING: The Rhode Island Sexually Transmitted Diseases (STD) Clinic from 2013 to 2016. METHODS: We report on the demographic and behavioral characteristics of all HIV-negative, cis-women who presented to the Clinic and of those who met Centers for Disease Control and Prevention (CDC) indications for PrEP. In a logistic regression analysis, we evaluated PrEP awareness among cis-women by year and demographic characteristics. We compared PrEP awareness among cis-women with PrEP awareness among cisgender men who have sex with men and among cisgender men who inject drugs presenting to the Clinic. RESULTS: Among 1431 HIV-negative cis-women, 84 (5.8%) met CDC indications for PrEP. PrEP awareness was significantly lower among Hispanic/Latina cis-women [11.0%; adjusted odds ratio (AOR): 0.46, 95% confidence interval (CI): 0.31 to 0.66] and non-Hispanic black cis-women (13.8%; AOR: 0.59, 95% CI: 0.39 to 0.89) relative to non-Hispanic white cis-women (20.7%). Men who have sex with men had significantly greater PrEP awareness (60.3%; AOR: 5.85, 95% CI: 3.35 to 10.23) than cis-women (22.9%). Only one woman reported PrEP use. CONCLUSIONS: Two-thirds of HIV-negative cis-women presenting for HIV/sexually transmitted disease testing and meeting CDC indications for PrEP were unaware of PrEP, and only one woman reported ever using PrEP. There is a critical need for public health professionals and health care providers to increase PrEP awareness and use among cis-women at risk for HIV.


Assuntos
Educação em Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Profilaxia Pré-Exposição , Doenças Sexualmente Transmissíveis/prevenção & controle , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Saúde Sexual , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/psicologia , Abuso de Substâncias por Via Intravenosa/psicologia , Estados Unidos/epidemiologia
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