What role does transactional sex play in the HIV/STI and reproductive health risk behaviour among high-tier entertainment centre workers in China?

China's rapid economic growth over the last three decades has led to increased population wealth and the proliferation of entertainment centres where people can conduct business, relax and meet new people. Little is known about the sexual risk behaviours of employees at high-tier entertainment centres. 

This paper addresses this gap in knowledge by comparing HIV risk perception and sexual and reproductive health behaviours among female and male employees at three high-tier entertainment centres in two cities in China, comparing those who report a history of transactional sex to those who do not. 

In both cities, participants who reported a history of transactional sex were more likely than those without a history of transactional sex to report multiple sexual partnerships, more lifetime sexual partners, a history of sexually transmitted infections (STIs), having anal sex and/or recent abortions, and were more likely to perceive themselves to be at risk for STIs/HIV. However, risk behaviour was also high among those with no history of transactional sex. 

These findings highlight the need for targeted sexual and reproductive health initiatives for employees in these work settings.

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By:  Mantell JE¹, LeVasseur MT, Sun X, Zhou J, Mao J, Peng Y, Zhou F, DiCarlo AL, Kelvin EA.

¹ HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute and Columbia University , New York , NY , USA.

Glob Public Health. 2015;10(8):947-67. doi: 10.1080/17441692.2015.1045918.

  

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Young adults with depression are at increased risk of sexually transmitted disease

Sexually transmitted diseases (STDs) and depression impact millions of individuals each year in the United States, with direct medical costs exceeding $41 billion. While the interactions of these conditions are poorly understood, they are increasingly addressed in primary care whereas historically they have been addressed separately. 

We analyzed data associated with the 18-25 year age group from the 2014 National Survey of Drug Use and Health, a cross-sectional survey of the civilian, non-institutionalized US population aged ≥12 years for factors associated with past year diagnosis of STD (STDy). Independent variables included participant demographics; lifetime diagnosis of major depressive episode (MDE); participant behaviors associated with STD risk (patient-provided); and medical record data associated with mental illness treatment (clinically-observed). 

Of 18,142 participants, the prevalence of MDE and STD was 15.3% and 2.4%, respectively, with significant differences by gender and race. MDE was associated with increased risk of STDy among females (odds ratio [OR]=1.61; 95% confidence interval [CI]=1.18-2.20), males (OR=2.32; CI=1.15-4.70), those of white race (OR=3.02; CI=2.02-4.53), and lower income levels and insurance status. Univariate modeling found that receiving mental health treatment, and use of marijuana, alcohol, and illegal drugs were each associated with significantly increased STDy. 

In a multivariate logistic regression, receiving mental health treatment became protective for STDy (AOR=0.55; CI=0.32-0.95]). Individuals with a history of depression are at increased risk of STDy, with this risk modified by factors readily ascertained within primary care. As depression treatment is increasingly incorporated into primary care there are means to more effectively target intervention resources.

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By:  Jenkins WD1, Botchway A2.

• 1Population Health Science Program, Southern Illinois University School of Medicine, 801 N. Rutledge St, Springfield, IL 62794-9664, United States. Electronic address: wjenkins@siumed.edu.
• 2Center for Clinical Research, Southern Illinois University School of Medicine, 801 N. Rutledge St, Springfield, IL 62794-9664, United States. 
• Prev Med. 2016 Apr 4. pii: S0091-7435(16)30042-1. doi: 10.1016/j.ypmed.2016.03.020

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Is the Risk for Sexually Transmissible Infections (STI) Lower among Women with Exclusively Female Sexual Partners Compared with Women with Male Partners? A Retrospective Study Based on Attendees at a Norwegian STI Clinic from 2004 to 2014

Background:

The prevalence of and the risk for sexually transmissible infections (STIs) for women engaging in same-sex sexual behaviour was investigated among women attending an STI clinic.

Methods:

Data from electronic medical records were reviewed and logistic regression used to estimate the odds ratio (OR) of STIs. Women reporting life-time exclusively female partners (WSW) and women reporting female and male partners (WSWM) were compared with women reporting exclusively male partners (WSM). Outcomes included: Chlamydia trachomatis, Mycoplasma genitalium, Neisseria gonorrhoea, HIV and syphilis.

Results:

The study population comprised 103 564 women (WSW 641, WSWM 12 010 and WSM 90 913). Overall prevalence of STIs was 8%. Crude OR of STIs for WSW: 0.56 (95% CI 0.39-0.81), for WSWM: 0.99 (95% CI 0.92-1.06) compared with WSM. Multivariate analysis revealed an interaction effect between same-sex sexual behaviour and smoking. Among non-smokers; WSW adjusted OR was 0.41 (95% CI 0.21-0.80), WSWM adjusted OR was 0.91 (95% CI 0.81-1.02) compared with WSM. Among smokers; WSW adjusted OR was 1.03 (95% CI 0.63-1.67) for WSWM adjusted OR was 1.00 (CI 95% 0.93-1.13), compared with WSM.

Conclusion:

This study, including the largest cohort of women reporting life-time exclusively female partners in an STI study, shows that WSW generally are at lower risk for acquiring STIs than WSM. Smoking WSW, however, had the same risk for acquiring bacterial STIs as WSM and WSWM. Our study suggests that all WSW should receive the same encouragement to test for STIs as WSM.

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By:  Sol-Britt Molin ^A B F, Birgitte Freiesleben De Blasio ^C D and Anne Olaug Olsen ^A B E 

^A Department of Rheumatology, Dermatology and Infectious Diseases, The Olafia Clinic p.o.b.4763, Oslo University Hospital, 0506 Oslo, Norway. 
^B Norwegian National Advisory Unit on Sexually Transmitted Infections, The Olafia Clinic p.o.b.4763, vv0506 Oslo, Norway. 
^C Oslo Centre for Biostatics and Epidemiology, Department of Biostatics, p.o.b1122 Blindern, Institute of Basic Medical Sciences, University of Oslo, 0317 Oslo, Norway. 
^D Department of Infectious Disease Epidemiology, Division of Infectious Disease Control, Norwegian Institute of Public Health, p.o.b.4404 Nydalen, 0403 Oslo, Norway. 
^E Institute of Clinical Medicine, University of Oslo, p.o.b.1171 Blindern, 0318 Oslo, Norway. 
^F Corresponding author. Email: solmol@ous-hf.no 

Sex Health. 2016 Apr 7. doi: 10.1071/SH15193. 

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Predictors of Perceived Male Partner Concurrency among Women at Risk for HIV & STI Acquisition in Durban, South Africa

Background

Women in sub-Saharan Africa continue to be at greater risk for HIV acquisition than men. Concurrency, viz. multiple sexual partnerships that overlap over time, has been studied as a possible risk factor for HIV transmission. The aim of this study was to identify predictors of perceived male partner concurrency among sexually active, HIV negative women.

Methods

Socio-demographic and behavioural data from women enrolled in a biomedical HIV prevention clinical trial were assessed in relation to perceived male partner concurrency using the Chi squared test. Univariate and multivariate logistic regression was performed to assess the independent predictors of perceived male partner concurrency. Kaplan–Meier survival estimates were obtained for HIV and STI incidence in relation to male partner concurrency. A Cox Proportional Hazards model was used to assess the association between perceived male partner concurrency and HIV and STI incidence.

Results

The results revealed that 29 % of women reported their male partners to be in concurrent sexual relationships, 22 % reported partners that were not engaging in concurrency, whilst 49 % reported not knowing their partners concurrency status. Older women, having never married, experiencing economic abuse, and women reporting individual concurrency, were found to be significant predictors of perceived male partner concurrency in the studied population. Perceived male partner concurrency was not found to be a significantly associated with incident HIV and STI infections in this analysis.

Conclusions

The study provides insight into predictors of perceived male partner concurrency among women at high risk for STI and HIV acquisition. These results may inform the design of behavioural and biomedical interventions, to address the role of multiple sexual partnerships in HIV prevention.

Below:  Kaplan-Meier survival curve for HIV incidence versus partner concurrency status, among a cohort of women in Durban, South Africa

Below:  Kaplan-Meier survival curve for STI incidence versus partner concurrency status, among a cohort of women in Durban, South Africa

Full article at:   http://goo.gl/PHHOQV

By:  Zakir Gaffoor, Handan Wand, Renée A. Street, Nathlee Abbai, and Gita Ramjee

HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa

The Kirby Institute, University of New South Wales, Sydney, Australia

Zakir Gaffoor, Phone: + (27)-31 242 3600

AIDS Res Ther. 2016; 13: 14. Published online 2016 Mar 8. doi:  10.1186/s12981-016-0098-7

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Prevalence & Risk Factors of Three Curable Sexually Transmitted Infections among Women in Nairobi, Kenya

BACKGROUND:

Sexually transmitted infections (STIs) are a major public health problem, especially in developing countries. The complications of untreated STIs in the female genital tract and their role in adverse pregnancy and perinatal outcomes have been well documented. The prevalence of STIs in Kenya among women in the general population has not been extensively studied and there is a lack of guidelines for screening of non-pregnant women. Knowledge of the prevalence of curable STIs among this population can provide a basis for integrating STI screening in family planning clinics.

METHODS:

A cross-sectional study was conducted between May and September 2013 at the family planning (FP) clinic at Kenyatta National Hospital (KNH) in Nairobi, Kenya. A total of 261 participants aged 18-49 years were enrolled; with data from 249 participants being analysed. An interviewer-administered questionnaire was used to gather socio-demographic data and assess for risk factors. Each participant was screened for Trichomonas vaginalis (TV) by wet mount microscopy; Neisseria gonorrhoeae (GC) by culture and Chlamydia trachomatis (CT) by PCR.

RESULTS:

The prevalence of CT was 13 % (33/249), TV 0.4 % (1/249) and GC 0 % (0/249). All the infected women reported having had only one sexual partner in the previous 1 year. The age group prevalence for CT was highest in the 25-29 years age group (21 %). The syndromic approach to the management of STIs showed a low specificity (vaginal discharge, 65.7 %; lower abdominal pain, 60.6 %) and positive predictive value (vaginal discharge, 14 %; lower abdominal pain, 11.5 %) for the two commonly used symptoms when compared to the gold standard of CT PCR.

CONCLUSION:

A high prevalence of CT was identified among women attending the FP Clinic at KNH. The study reinforces the need to implement regular screening for STIs among FP clinic attendants. It also reveals the need to review the usage of the syndromic approach for the management of STIs.

Characteristics of CT positive participants

Characteristics	Chlamydia infections/n	Prevalence (%)	P value
Age group
<25	1/13	8
25–29	6/28	21
30–34	6/56	11
35–39	10/67	15
40–44	8/48	17
45–49	2/37	5
Marital status
Married	29/211	14	0.59
Not married	4/38	11
Education level
Primary and below	11/67	16	0.37
Above primary	22/182	12
Occupation
Paid employment	11/83	13	0.9
Self employed	16/127	13
Unemployed	6/39	15
Coitarche
≤20 years	21/160	13	0.95
>20 years	10/78	13
Treated STIs
No	32/224	14	0.22
Yes	1/25	4

Full article at:   http://goo.gl/zLt0e0

By:  Maina AN1, Kimani J2, Anzala O3.

• 1Department of Medical Microbiology, University of Nairobi, P.O BOX 19676-00202, Nairobi, Kenya. acnmaina@yahoo.com.
• 2Kenya AIDS Control Project, University of Manitoba/Nairobi Collaborative Research Group, P.O BOX 19676-00202, Nairobi, Kenya.
• 3KAVI Institute of Clinical Research, University of Nairobi, P.O BOX 19676-00202, Nairobi, Kenya.
• BMC Res Notes. 2016 Mar 29;9(1):193. doi: 10.1186/s13104-016-1990-x. 

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Social Support Quality & Availability Affects Risk Behaviors in Offenders

Background

People involved in the justice system are at 2.5 times the risk of HIV infection compared to the general population, which is further complicated by substance abuse. The purpose of this study was to evaluate the role of social network quality and quantity on unprotected sex, criminal risk, and substance use.

Methods

We used data from 330 drug-involved offenders. Structural equation modeling (SEM) was used to model and test path directionality and magnitude between the latent constructs of social support quality and quantity on risky behaviors.

Results

The SEM indicated the latent construct of social support quality was significantly associated with reduced sexual risk behavior (β = −0.27), criminal risk (β = −0.26), and reduced substance use (β = −0.33). Additionally, the proposed model found that social support quantity was significantly positively associated with increased sexual risk behavior (β = 0.40) and substance use (β = 0.20).

Conclusions

Social support quality is an important predictor of risky behaviors; as the quality of an offender’s social support increases, engagement in risky behaviors decreases. Probationers who had broader social support availability also had increased substance use and unprotected sex. Probation systems may be able to reduce substance use and STD/HIV infection risk in offenders by strengthening the quality of social support networks.

Below:  Structural Model of Social Support Quality and Quantity on Risk Taking Behaviors

Full article at:   http://goo.gl/VmUAv0

By:  Stephanie A. Spohr, Sumihiro Suzuki, Brittany Marshall, Faye S. Taxman, and Scott T. Walters

University of North Texas Health Science Center, Fort Worth, USA

George Mason University, Fairfax, VA USA

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Risk Factors Associated with Incident Sexually Transmitted Infections in HIV-Positive Patients in the Australian HIV Observational Database

OBJECTIVES:

We established a subcohort of HIV-positive individuals from 10 sexual health clinics within the Australian HIV Observational Database (AHOD). The aim of this study was to assess demographic and other factors that might be associated with an incident sexually transmitted infection (STI).

METHODS:

The cohort follow-up was from March 2010 to March 2013, and included patients screened at least once for an STI. We used survival methods to determine time to first new and confirmed incident STI infection (chlamydia, gonorrhoea, syphilis or genital warts). Factors evaluated included sex, age, mode of HIV exposure, year of AHOD enrolment, hepatitis B or C coinfection, time-updated CD4 cell count, time-updated HIV RNA viral load, and prior STI diagnosis.

RESULTS:

There were 110 first incident STI diagnoses observed over 1015 person-years of follow-up, a crude rate of 10.8 per 100 person-years. Factors independently associated with increased risk of incident STI included younger age [≥ 50 vs. 30-39 years old]; prior STI infection, and heterosexual vs. men who have sex with men (MSM) as the likely route of exposure.

CONCLUSIONS:

In this cohort of individuals being treated with antiretroviral drugs, those who were MSM, who were 30-39 years old, and who had a prior history of STI, were at highest risk of a further STI diagnosis.

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By:  Mulhall BP1,2, Wright ST1, De La Mata N1, Allen D3, Brown K2,4,5, Dickson B6, Grotowski M7, Jackson E8, Petoumenos K1, Foster R1,9, Read T10, Russell D11,12, Smith DJ13, Templeton DJ1,14, Fairley CK10,12, Law MG1.

• 1The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
• 2University of Sydney, Camperdown, NSW, Australia.
• 3Holden Street Sexual Health Clinic, Gosford, NSW, Australia.
• 4Illawarra Sexual Health Services, Warrawong, NSW, Australia.
• 5University of Wollongong, Wollongong, NSW, Australia.
• 6Caradata, Arundel DC, Qld, Australia.
• 7Tamworth Sexual Health, Clinic 468, HNEAHS, NSW, Australia.
• 8Nepean/Blue Mountains Sexual Health, Nepean Hospital, Kingswood, NSW, Australia.
• 9Sydney Sexual Health Centre, Sydney, NSW, Australia.
• 10Melbourne Sexual Health Centre, Alfred Hospital, Prahran, Vic., Australia.
• 11Cairns Sexual Health Service, Cairns, Qld, Australia.
• 12Central Clinical School Monash University, Alfred Hospital, Melbourne, Vic., NSW, Australia.
• 13Lismore Sexual Health Services, Lismore, NSW, Australia.
• 14RPA Sexual Health, Camperdown, NSW, Australia. 
• HIV Med. 2016 Mar 28. doi: 10.1111/hiv.12371

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Client-Perpetrated & Husband-Perpetrated Violence among Female Sex Workers in Andhra Pradesh, India: HIV/STI Risk Across Personal & Work Contexts

OBJECTIVES:

This study examines violence experienced in work and personal contexts and relation to HIV risk factors in these contexts among female sex workers (FSW) in Andhra Pradesh, India.

METHODS:

FSW at least 18 years of age (n=2335) were recruited through three rounds of respondent-driven sampling between 2006 and 2010 for a survey on HIV risk. Using crude and adjusted logistic regression models, any sexual/physical violence (last 6 months) perpetrated by clients and husbands were separately assessed in association with accepting more money for sex without a condom (last 30 days), consistent condom use with clients and husbands (last 30 days), and sexually transmitted infection (STI) symptoms (last 6 months).

RESULTS:

The mean age among participants was 32, 22% reported being currently married, and 22% and 21% reported physical/sexual violence by clients and husbands, respectively. In adjusted logistic regression models, FSW who experienced client violence were more likely to report accepting more money for unprotected sex trades (adjusted OR (AOR)=1.7; 95% CI 1.4 to 2.2), less likely to report consistent condom use with clients (AOR=0.6; 95% CI 0.5 to 0.7) and more likely to report STI symptoms (AOR=3.5; 95% CI 2.6 to 4.6). Women who reported husband violence were more likely to report accepting more money for unprotected sex trades (AOR=2.1; 95% CI 1.2 to 3.7), less likely to report consistent condom use with clients (AOR=0.5; 95% CI 0.3 to 0.8) and more likely to report STI symptoms (AOR=2.6; 95% CI 1.6 to 4.1).

CONCLUSIONS:

Among FSW, experiences of violence in work and personal contexts are associated with sexual HIV risk behaviours with clients as well as STI symptoms.

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By:  Reed E1, Erausquin JT2, Groves AK3, Salazar M1, Biradavolu M3, Blankenship KM3.

• 1Division of Global Public Health, School of Medicine: La Jolla, University of California, San Diego, CA, USA.
• 2Department of Public Health Education, University of North Carolina, Greensboro, Greensboro, NC, USA.
• 3Department of Sociology, American University, Washington DC, USA. 
• Sex Transm Infect. 2016 Feb 23. pii: sextrans-2015-052162. doi: 10.1136/sextrans-2015-052162.

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Family-Based HIV & Sexually Transmitted Infection Risk Reduction for Drug-Involved Young Offenders: 42-Month Outcomes

This study tested a family-based human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention approach integrated within an empirically supported treatment for drug-involved young offenders, Multidimensional Family Therapy (MDFT). 

A randomized, controlled, two-site community-based trial was conducted with 154 youth and their parents. Drug-involved adolescents were recruited in detention, randomly assigned to either MDFT or Enhanced Services as Usual (ESAU), and assessed at intake, 3, 6, 9, 18, 24, 36, and 42-month follow-ups. Youth in both conditions received structured HIV/STI prevention in detention and those in MDFT also received family-based HIV/STI prevention as part of ongoing treatment following detention release. Youth in both conditions and sites significantly reduced rates of unprotected sex acts and STI incidence from intake to 9 months. They remained below baseline levels of STI incidence (10%) over the 42-month follow-up period. 

At Site A, adolescents who were sexually active at intake and received MDFT showed greater reduction in overall frequency of sexual acts and number of unprotected sexual acts than youth in ESAU between intake and 9-month follow-ups. These intervention differences were evident through the 42-month follow-up. Intervention effects were not found for STI incidence or unprotected sex acts at Site B. 

Intensive group-based and family intervention in detention and following release may reduce sexual risk among substance-involved young offenders, and a family-based approach may enhance effects among those at highest risk. Site differences in intervention effects, study limitations, clinical implications, and future research directions are discussed.

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By:  Rowe CL1, Alberga L1, Dakof GA1, Henderson CE2, Ungaro R1, Liddle HA1.

• 1Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL.
• 2Department of Psychology, Sam Houston State University, Huntsville, TX.
• Fam Process. 2016 Feb 16. doi: 10.1111/famp.12206 

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Sex Workers, Condoms & Mobility among Men in Uzbekistan: Implications for HIV Transmission

Uzbekistan has one of the fastest growing HIV epidemics in the world. In this study, men who reported mobility were compared to non-mobile men in regard to paying for sex and condom use during paid sex. 

The sample included 2333 men between the ages of 15 and 59 in Uzbekistan. Generalised linear models were used to assess the relationship between mobility, paid sex, and condom use while adjusting for possible confounders. 

Of the total sample, 

• 4.4% reported engaging in paid sex and 
• 42% reported using condoms while engaging in paid sex. 
• Mobile men were found to have more than three times the odds of paid sex than non-mobile men. 
• Mobile men were not significantly different from non-mobile men in terms of condom use; 
• However, unmarried men were found to have six times the odds of not using a condom when compared to married men during paid sex. 
• Only one of the men who reported paid sex also reported using a condom with their spouses at last intercourse. 

The findings contribute to understanding mobility and HIV risk, and have important implications for HIV prevention interventions.

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By:  Smolak A1, El-Bassel N2, Malin A2, Terlikbayeva A3, Samatova S2.

• 1Global Health Research Center of Central Asia, Columbia University, New York, NY, USA as3234@columbia.edu.
• 2Global Health Research Center of Central Asia, Columbia University, New York, NY, USA.
• 3Global Health Research Center of Central Asia, Almaty, Kazakhstan. 

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