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Findings are reported from 1780 young male clients of the California Office of Family Planning's Expanded Teen Counseling Program's (ETCP) family planning clinics during 1992-94 on their sexual behavior, contraceptive use, pregnancy and parenting history, and psychosocial characteristics. 37% were Hispanic, 30% White, 18% Black, 12% Asian, and 6% members of other racial or ethnic groups. 14% were aged 14 years or younger, 50% were aged 15-17, and 36% were aged 18-19. 9% reported having Medicaid insurance and 3% received Aid to Families with Dependent Children. 31% of the young men reported going to the clinic in search of a birth control method, 27% to determine whether they were infected with an STD, 26% for a physical exam, 22% because their partner or girlfriend wanted them to, and 15% for information or someone to talk to. 88% reported recent episodes or symptoms of depression and 23% were having problems in school. 86% were currently sexually active, with 48% of those sexually active being age 14 or younger when they had their first sexual encounter. 73% reported using a condom at first sexual intercourse, while 12% had never used a contraceptive method. 50% reported using a condom the last time they had sexual intercourse, 71% of condom users reported being comfortable with the method, 21% had impregnated a partner and 8% were parents, and 25% reported having 4 or more sex partners during the past 6 months. 9% reported ever having an STD, 31% reported being always or sometimes high on alcohol or drugs during sex, and 6% reported having been forced or tricked into having sex. The odds were reduced that a client had used an effective method at last intercourse if he was uncomfortable with that method. The likelihood of contraceptive use at last intercourse was increased among males who agreed with their partner about their method and those who had never impregnated a partner.
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PMID:A profile of the adolescent male family planning client. 956 70

Approximately 25%-50% of women with sexually transmitted diseases (STDs), including AIDS, are involved in abusive relationships. Numerous characteristics associated with a past history of abuse are also risk factors for STD infection, including multiple partner relationships, substance abuse, early age at first coitus, and partner control of the relationship. Research has identified psychological effects of previous abuse, including depression, minimal control in relationships, and decreased self-efficacy. These effects may prevent abused women with STDs from making behavioral changes to prevent recurrence and transmission of disease. Life history methodology was used to understand the context of the interrelationships between STD and woman abuse in 30 Mexican American and African American women's lives. A focus on the context of abused women's partner relationships and aspects of personal control within these relationships may facilitate effective behavioral change, risk reduction, and subsequent decrease in incidence of STDs and woman abuse.
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PMID:The context of sexually transmitted disease: life histories of woman abuse. 978 63

Our objectives were to evaluate tolerance and compliance of post-exposure triple therapy in health-care workers (HCWs) by retrospective observational study. Structured telephone interview of HCWs identified through data from antiretroviral prescribing centres. Twenty HCWs who received triple prophylaxis were identified over one year. Sixteen agreed to participate in the study. All but one source patient had documented HIV infection. Half HCWs were not aware of post-exposure therapy. Most HCWs received a zidovudine, lamivudine and indinavir combination. All completed at least 4 weeks of therapy. Only 50% received their first dosage less than 4 h after exposure. Nearly all experienced adverse events, mostly digestive (nausea and abdominal pain n=15) or psychological (anxiety and depression n=15), none resulting in therapy discontinuation. Most events occurred 2 to 7 days after therapy initiation. Most modified their sexual life with abstinence or condom use. Compliance was excellent. Half HCWs did not miss any tablet, 4 forgot one dosing a month and 4 one dosing a week. Follow up is over 6 months in all but one HCW. No HIV seroconversion has been observed to date. In France, post-exposure triple antiretroviral therapy is widely available 24 h a day in every emergency room but further training and development of HCWs is needed to decrease consulting time and increase referral to specialized physicians. Notable moderate adverse events, both physical and psychological are noted, however, compliance is excellent.
Int J STD AIDS 1998 Oct
PMID:Tolerance, compliance and psychological consequences of post-exposure prophylaxis in health-care workers. 981 9

The aim was to determine the association between frequency of alcohol use in the past 30 days and HIV-related risk behaviours among adults in an African-American community. Data were collected by trained street outreach workers, from 522 persons in 4 areas selected on the basis of 7 health and criminal justice indicators of high risk for HIV, STD and substance abuse, and drug-related arrests. A survey assessed demographics, substance use, sexual behaviour, HIV knowledge, attitudes and depression. Subjects reporting using drugs other than alcohol (n=201) were excluded from analyses to avoid the confounding influence of polysubstance use. Of the remaining 321 subjects (mean age=37.1; 58.5% were male), 43.6% reported no alcohol use in the past 30 days, with 37.4% and 19.0%, respectively, having used alcohol < =15 days and = > 16 days in the past 30 days. Alcohol use frequency (no alcohol, 1-15 days, 16-30 days in past month) was significantly associated with being male, STD history, non-use of condoms, higher perceived risk of HIV, lower condom use self-efficacy, multiple sex partners in the past 30 days, and lower HIV-related knowledge. Frequent alcohol use, in the absence of other drugs, is associated with higher levels of HIV risk behaviours. Though an underserved population with respect to HIV prevention and, given the prevalence of alcohol use, the findings suggest that programmes need to target frequent alcohol users to reduce their HIV-associated risk behaviours and enhance HIV risk-reduction knowledge and attitudes associated with the adoption of HIV prevention practices.
Int J STD AIDS 1998 Oct
PMID:Frequency of alcohol use and its association with STD/HIV-related risk practices, attitudes and knowledge among an African-American community-recruited sample. 981 13

Condom promotion remains the primary method of HIV prevention for sexually active couples. Measurement of condom use--essential for the evaluation of AIDS prevention programs--is impeded, however, by factors such as self-report bias, participation bias, test-retest reliability problems, social desirability responses, and memory error. Standardized methodology in studies where condom use is the dependent variable would allow for more accurate calculation of effect size and enable application of meta-analytical tools needed to avoid Type II errors. Recommended, to improve measurement of condom use, are the following: 1) separate measurement of condom use for receptive and insertive partners; 2) consideration of the multiple contingencies that exist for a participant to adopt long-term condom use for HIV prevention; 3) recognition that the person must be able to negotiate within the confines of competing threats to survival (e.g., violent reprisals); 4) use of intent to conceive a child as a covariate; 5) requirement that the person is motivated by the threat of HIV rather than by pregnancy prevention or prevention of the spread of an existing STD; 6) determination of the participation of the sex partners in the decision to use condoms for HIV prevention; 7) account for temporal factors such as depression or alcohol intoxication; 8) measurement of condom use data in the form of ratio rather than interval data; 9) quantification of acts of unprotected sex rather than proportion of condom use; and 10) where possible, use of a within-subject design for evaluation of the treatment effect.
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PMID:Condom use as a dependent variable: measurement issues relevant to HIV prevention programs. 988 89

Homeless youth suffer from high rates of health problems, yet little is known about their perceptions of or context for their own health issues. In this study, a combination of qualitative techniques from participatory rural appraisal and rapid assessment procedures was used to investigate the perceptions of health needs of shelter-based youth in Baltimore, MD in the U.S.A. The most common youth-identified health problems included STDs, HIV/AIDS, pregnancy, depression, drug use and injuries. These correlate well with more objective health status data for the same youth. The youth spoke of environmental safety threats of violence and victimization by adults, as well as racism and sexism in their lives. Youth reported that trusted adult figures such as grandmothers are important sources of health advice. Many homeless youth from less than ideal family situations remain in contact with and continue to seek advice from parents and other family members. Health interventions with urban street youth need to acknowledge the primacy of the social context for these youth, as well as the reality of violence as a daily health threat.
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PMID:Health and access to care: perspectives of homeless youth in Baltimore City, U.S.A. 1007 49

The purpose of this study was to test the outcomes of group psycho-educational intervention (PEI) led by nurses on sexual health risks (knowledge, behaviour, disease burden) and psycho-social adaptation (depression, mood states, self-efficacy) in young adults with the chronic disease, genital herpes. Two hundred and fifty-two young adults with symptomatic genital herpes participated in a randomized controlled trial (RCT). The intervention was participation in a three-session group PEI facilitated by a nurse in the community. Participants completed questionnaires measuring sexual health risks (herpes knowledge, sexual risk behaviour, disease burden of patterns of recurrences of outbreaks of the disease), and psycho-social adaptation (depression using the Beck Depression Inventory [BDI], mood states using the Profile of Mood States [POMS], and feelings of self-efficacy for protection from sexually transmitted diseases [PSTD]) at induction into the study, and at 3 and 6 months. Participants were mainly employed, Caucasian, single women in their twenties (X = 27.1 years, SD = 4.3), with some college education; 23% of the sample were men. After controlling for baseline knowledge about genital herpes, the experimental group had significantly more knowledge than the control group at 3 and 6 months' post-intervention. They also reported using condoms and spermicides to prevent the spread of genital herpes more often than did the control group. The implications for nurses in the community include the following: (a) PEI is an intervention that can be used by nurses in the community with a high-risk population; (b) group intervention is a viable treatment for people with a highly stigmatized, chronic sexually transmitted disease (STD); and (c) further testing of the use of PEI by nurses in the community with other high-risk populations is needed.
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PMID:Effects of psycho-educational interventions on sexual health risks and psycho-social adaptation in young adults with genital herpes. 1021 75

Young Aboriginal men face marginalization distinct in cause but similar in pattern to those seen among men who have sex with men (MSM) and may be at increased risk for HIV infection. We compared sociodemographic characteristics and risk taking behaviours associated with HIV infection among MSM of Aboriginal and non-Aboriginal descent. Data for this comparison were gathered from baseline questionnaires completed by participants in a cohort study of young MSM. Data collection included: demographic characteristics such as age, length of time residing in the Vancouver region, housing, employment, income and income sources; mental health and personal support; instances of forced sex and sex trade participation and; sexual practices with regular and casual male sex partners. Data were available for 57 Aboriginal and 624 non-Aboriginal MSM. Aboriginal MSM were significantly less likely to be employed, more likely to live in unstable housing, to have incomes of <$10,000 and to receive income assistance than non-Aboriginals (all P<0.01). Aboriginals also had higher depression scores (P<0.01), were more likely to report non-consensual sex (P=0.03), sexual abuse during childhood (P=0.04) and having been paid for sex (P<0.01). In the past year they were no more likely to have had sex with a male partner they knew to be HIV positive, to have had more than 50 male partners or to have unprotected anal insertive or receptive intercourse with their male partners (all P>0.05). Our data indicate that among MSM, Aboriginal men are at increased risk of antecedent risk factors for HIV infection including sexual abuse, poverty, poor mental health and involvement in the sex trade.
Int J STD AIDS 1999 Sep
PMID:HIV-associated risk factors among young Canadian Aboriginal and non-Aboriginal men who have sex with men. 1049 24

For a long time, the sexual behaviour of HIV-infected persons did not receive any serious attention for a variety of reasons. Initially, diagnosis of HIV-infection appeared to imply a death sentence. In this context, the sex life of those infected seemed a secondary issue making prevention focused on sexual behaviour hard to imagine. Furthermore, the conviction that stigmatisation should be avoided also precluded an interest in the sexual behaviour of HIV-infected persons. From an epidemiological perspective and in the context of the developments in the medical treatment of AIDS it is important to address the sexuality of HIV-infected people. The scarce research done until now shows that there are various ways in which an HIV-infection affects people's sexuality. It seems that the sexuality of HIV-infected people can be compromised by their infection, inducing various sexual problems. Research also shows that there are HIV-infected people who do engage in unprotected sex, just as there are HIV-negative people or people with unknown serostatus who do so. Studies into the determinants of unsafe sex in HIV-infected people suggest that to some extent the same determinants are operative as among people in general. These include intention and self-efficacy regarding safe sex. Recreational drug use also affects safe sex regardless of serostatus. However, safe sex as well as sex in general is different for seropositive persons than for people who are seronegative or have an unknown serostatus. Among seropositive people, sex is also related to dilemma's involving disclosing their serostatus to potential sex partners, and their motivation to protect their partners as well as themselves against surinfection and STD. Furthermore, having to cope with a serious disease induces negative mood states (particularly depression) and may compromise sexual functioning. Comprehensive prevention aimed at HIV infected persons should address these various issues and should be an integrated part of general HIV-prevention.
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PMID:HIV-positive people, risk and sexual behaviour. 1079 64

Genital herpes is a chronic, stigmatizing, sexually transmitted disease (STD), which is increasing despite efforts to control its spread. Depression is commonly reported among people diagnosed with genital herpes and differences in depression by gender have been reported. Therefore, the purpose of this study was to identify gender differences in the predictors of depression in young adults with genital herpes by secondary analyses of baseline data from a randomized clinical trial (RCT). For the RCT, young adults (193 females, 59 males) with genital herpes were recruited from newspaper advertisements. Participants completed questionnaires measuring illness burden, attitudes toward herpes, stress symptoms, mood states, depression, self-concealment, self-disclosure, substance use, and demographics. Univariate analyses and multiple regression techniques were used to identify variables predictive of depression in this sample. In women, increased anger, decreased vigor, increased confusion, a negative attitude toward herpes, self-concealment, and stress symptoms from genital herpes predicted more depression (R2 = 0.63). In men, increased depression was predicted by increased anger, a negative attitude toward herpes, and a decreased willingness to share personal information with a stranger (R2 = 0.51). Findings suggest that future psychoeducational interventions should address anger as a predictor of depression in this population. Gender-specific interventions need to be developed in order to assist young adults who are living with genital herpes.
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PMID:Gender differences for the predictors of depression in young adults with genital herpes. 1084 Feb 88


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