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Venereal disease (VD) was probably introduced to New Guinea by Europeans. This paper attempts a description of the correlation between social factors and VD in Port Moresby, Papua New Guinea, where 50 military VD patients, 250 military controls, 200 civilian VD patients, and 30 prostitutes were interviewed either at the VD clinic of the Taurama Hospital, or at the army clinic. Among army patients 62% had gonorrhea and 38% other VDs; 38% had been drinking and 24% were drunk at the time of the contact; in 76% of cases sexual intercourse had been with prostitutes; only 6% of military patients had had previous venereal infection. Among the civilians 91% had acquired their infection from prostitutes; in 51% of cases intercourse occurred out of doors; only 15% of civilians had been previously infected. Of the 30 prostitutes 50% were under 21 and 15 were between 21-30; many were married. The total weekly income from prostitution was much higher than the standard male laborer's weekly salary. The immigration of unaccompanied male laborers from rural areas accounts for the excess male indigenous population at Port Moresby, and it is greatly conducive to the development of prostitution, well established in certain suburbs. Many women who accompany their husband or brothers to the city become prostitutes with their encouragement; these women have no education, are of the lowest social status, and provide their pimp with a substantial income. Among the group of people studied in this article soldiers mainly made contact with professional prostitutes during their leisure time and at one of the well known meeting places. The attitudes of New Guineans to VD is closely related to their degree of education. Among the less educated there is disregard toward some forms of VD, and moderately painful lesions are often self-treated before seeking medical attention. Among patients with moderate education refusal to accept cure was a common feature, but depression was common. Among the better educated hypochondriasis was common, with persistent and undue concern over urethral secretions.
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PMID:Social and psychological aspects of venereal disease in Papua New Guinea. 448 75

There are currently numerous well-woman clinics in Britain which emphasize a specific aspect of health care, including cervical cancer screening (134 centers), family planning (142 centers), antenatal care (162 clinics), and venereal disease control (15 clinics). However, care provided in these clinics is fragmentary and excludes certain population groups from coverage. For example, cervical cancer smears are largely sought by upper class women under age 35, although this cancer has a higher incidence among older women from the lower social classes. Similarly, family planning clinics are not attracting women at highest risk of repeat abortion. Antenatal clinics, although effective in reducing perinatal and maternal mortality, exclude women beyond the childbearing years. At present, there are less than 10 comprehensive well-woman clinics in Britain. However, an estimated 17 million women could benefit from such a service, especially if cervical cytology screening was absorbed within it. A comprehensive clinic could focus on medical problems common to women, including menopause, frigidity, child abuse, obesity, thyroid disease, and depression. Omissions created by fragmented care, such as failure to test for conditions like anemia, could be avoided. The Manchester well-woman clinic, set up in 1981, provides an example of the role such clinics could play. The clinic is targeted at women who rarely see a general practitioner, e.g., poor, infertile, older women. Its emphasis is on the prevention and early detection of disease. Treatment is limited to self-help support groups and discussions with staff; however, new attendees are screened by a physician and nurse. 99% of attendees were found to have at least 1 medical problem. 2/3 of these problems, including breast problems, vaginal discharge, menopause problems, depression, and headache, were not already being treated. This experience suggests that there is an untapped need for such a facility, especially among women between menopause and old age.
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PMID:Evaluating well-woman clinics. 688 41

The purpose of this study was to compare the obstetrical care provided by three different groups of physicians. Deliveries between July 1975 and July 1977 were tabulated and all 211 deliveries of the family physician (FP) group, and all 199 of the family practice residency (FPR) group were reviewed, as were a randomly selected group of 193 obstetrician (OB) deliveries. All hospital charts were reviewed for 81 variables. The FPR group had more patients who were poor, single, and nulliparous. They presented later in pregnancy, were more often anemic, and had an increased incidence of venereal disease. The FPR and FP groups documented major psychological problems and depression more frequently. The obstetricians used caudal and epidural anesthesia more frequently, whereas the FP and FPR groups used more narcotics. Except for an increased incidence of third degree lacerations in the FP group, total maternal and fetal complications were few and similarly divided among the groups. The FPR and FP groups delivered 78 percent and the OB group 38 percent of their own patients. This paper is an addition to a limited literature base which deals with process and outcome of obstetrical care delivered by various provider groups and is unique in that the study was undertaken in a large prepaid group.
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PMID:Obstetrical care in a prepaid cooperative: a comparison between family practice residents, family physicians, and obstetricians. 742 36

Twenty HIV positive and 68 HIV negative subjects were assessed by the Hospital Anxiety and Depression Scale and by the Alcohol and Drugs Frequency Schedule immediately prior to notification of their HIV serostatus and 6 months after serodiagnosis. The 2 groups did not differ significantly in levels of anxiety or depression at baseline or follow-up. There were borderline levels of pathological anxiety prior to notification of HIV serostatus in both groups. The drop to normal levels of anxiety which had occurred by follow-up was significant in the HIV positive group. About a third of subjects in both groups were regularly making use of alcohol and/or drugs, both at baseline and follow-up. Mean levels of weekly alcohol intake for both groups ranged from about 20 to 30 units per week. The drugs most commonly used (in any frequency) were nitrates ('poppers') and cannabis.
Int J STD AIDS
PMID:Long-term impact of HIV diagnosis on mood and substance use--St Stephen's cohort study. 794 53

From May 1989 through April 1990, 1,001 adult homosexual and bisexual men attending urban sexually transmitted disease clinics were interviewed regarding abusive sexual contacts during childhood and adolescence. Sexual abuse was found to be significantly associated with mental health counseling and hospitalization, psychoactive substance use, depression, suicidal thought or actions, social support, sexual identity development, HIV risk behavior including unprotected and intercourse and injecting drug use, and risk of sexually transmitted diseases including HIV infection. Data suggest that sexual abuse may have a wide-ranging influence on the quality of life and health risk behavior of homosexual men. Increased awareness as to the potential outcomes of male sexual abuse is critically important to the design and implementation of medical and psychological services for sexually abused men.
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PMID:Emotional, behavioral, and HIV risks associated with sexual abuse among adult homosexual and bisexual men. 800 Sep 5

Greater understanding of psychosocial predictors of the use of condoms among Hispanics is needed in prevention efforts related to the human immunodeficiency virus and sexually transmitted disease epidemics among Hispanics in the United States. A telephone survey was carried out in nine States that have large populations of Hispanics, using a stratified clustered random digit dialing sampling strategy. The survey yielded interviews with 968 Hispanic men ages 18-49 years. Of them, 361 (37.8 percent) reported at least one secondary female sexual partner in the 12 months prior to the interview. Predictors were identified of condom use by those men with their secondary sex partners. Key predictors of the subjects' condom use with secondary partners included carrying condoms; self-efficacy, or a measure of the subject's perceived ability to use condoms under difficult circumstances; positive attitude toward condom use; having friends who used condoms; and lack of symptoms of depression in the week before the interview (R2 = 0.35). Significant predictors of condom carrying were being comfortable in sexual situations, positive attitude toward condom use, and self-efficacy to use condoms. Less acculturated men had more positive attitudes toward condom use and carried them more than did more acculturated men. The researchers found encouraging levels of condom use with secondary sexual partners among Hispanic men with multiple partners. Because of the large proportion of Hispanic men who have multiple partners and the severity of the sexually transmitted disease epidemics in the Hispanic community,health care providers should recommend to Hispanic men that they carry and use condoms,point out the acceptability of men using condoms,and assess and teach basic sexual information in that group. Referral may be appropriate for high risk Hispanic men with symptoms of depression.
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PMID:Condom use among Hispanic men with secondary female sexual partners. 826 59

The American Social Health Association (ASHA) surveyed people with human papillomavirus (HPV) about their experiences with the disease and its effect on their lives. A sample of 837 was chosen from the subscribers to HPV News, ASHA's quarterly journal for people with HPV. Of the sample, 489 returned completed surveys, which addressed medical history, health care experiences, personal impact, and demographic information. Data analysis was descriptive. Data illustrated that the psychosocial impact of HPV can be serious. More than three-quarters of respondents reported feelings of depression and anger, and two-thirds feelings of shame. Sexual enjoyment and activity were also negatively affected by HPV. Additionally, respondents expressed dissatisfaction with the diagnosing health care providers' counselling on emotional and sexual issues. These results may be instructive to those delivering health services by providing insight into the significant personal impact of HPV on those infected.
Int J STD AIDS
PMID:The psychosocial impact of human papillomavirus infection: implications for health care providers. 879 82

We aim to assess the age-related differences in psychological stress and depression in patients with human immunodeficiency virus (HIV) infection. Prospective, longitudinal, observational study of patients with HIV followed at a university affiliated VA Medical Center. Fifty-six consecutive patients with HIV infection aged 19-68 were studied. Data on demographics, living arrangements, education, employment, income, social, religious, and community support, medical status, psychological stress, depression, and coping was assessed at baseline and every 6 months. Instruments for psychological testing included Beck Depression Inventory, Profile Mood Status (POMS) scale and ways of coping scale (inventory of coping with illness scale). Sixty-nine per cent (38/56) of the patients were older than 35 years of age. Older patients exhibited significantly greater emotional and psychological stress; the mean POMS score for older patients was 56.8 as compared to 21.5 for younger patients (P = 0.004). Older patients had significantly greater depression (P = 0.001), higher tension and anxiety (P = 0.005), greater anger and hostility (P = 0.03), greater confusion and bewilderment (P = 0.01), and more fatigue (P = 0.003) as compared with younger patients. Older patients were significantly more likely to have intravenous drug use as an HIV risk factor (P = 0.02), less likely to be employed (P = 0.005), and more likely to use non-traditional therapies (P = 0). Intravenous drug use was an independent predictor of psychological stress in older patients. Patients with HIV, older than 35 years of age, are significantly more likely to suffer from depression and psychological stress; intravenous drug use was an independent predictor of stress. Interventions for the treatment of depression should be especially sought in this subgroup of patients with HIV.
Int J STD AIDS 1997 Apr
PMID:Psychological stress and depression in older patients with intravenous drug use and human immunodeficiency virus infection: implications for intervention. 914 58

Genital herpes causes considerable psychological and psychosexual morbidity. The most common emotional responses are depression, anguish, anger, diminution in self-esteem and hostility towards the person believed to be the source of the infection. These emotional problems appear to be worse in women than in men. The psychological morbidity in patients with first episode genital herpes is statistically significantly greater than that occurring in non-herpes patients attending sexually transmitted disease clinics. It was previously believed that stressful life events could precipitate recurrences. However, recent studies suggest that ongoing recurrences cause the emotional stress rather than vice versa. There is some evidence that premorbid personality may effect recurrence rates, but an equally plausible explanation is that frequent recurrences adversely affect personality. Long-term aciclovir suppression significantly reduces the psychological morbidity associated with recurrent genital herpes, over at least the period of treatment. Cognitive coping strategies and social support from a partner appear to assist with adjustment. Improving a patient's problem-solving skills, and long-term aciclovir therapy should form an integral part of the long-term management of recurrent genital herpes.
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PMID:Psychological and psychosexual implications of herpes simplex virus infections. 916 20

This article describes risky drug and sexual behavior and mental health characteristics in a sample of 240 homeless or drug-recovering women and their most immediate sources of social support. Women and their closest support sources both reported a great deal of recent noninjection drug use (56% and 52%, respectively) and lesser, though similar amounts of recent injection drug use (12% and 14%, respectively). More than one third of both groups reported a history of sexually transmitted disease and sexual activity with multiple partners. Fifty-one percent of the women and 31% of their support sources had Center for Epidemiological Studies Depression Scale (CES-D) scores of 27 or greater, suggesting a high level of depressive disorders in both samples. Similarly, 76% of the women and 59% of their support sources had psychological well-being scores below a standard clinical cutoff point. These data suggest that homeless and impoverished women turn to individuals who are themselves at high risk for emotional distress and risky behaviors as their main sources of support.
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PMID:HIV-risk behaviors and mental health characteristics among homeless or drug-recovering women and their closest sources of social support. 917 2


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