Episode Of Sexual Intercourse Research Articles

Sexual orientation, use of drugs and risk perception among HIV-positive men in São Paulo, Brazil

The aim of this cross-sectional study, carried out among 250 HIV-positive (HIV+) men who have sex with women, was to describe their risk perception before learning of their HIV+ status and their sexual and drug use behaviour. Of the 250 men, 62.0% were heterosexuals and 38.0% where bisexuals. They most often reported becoming infected through unprotected sex (24.5%) and injecting drug use (11.0%). They were usually tested because they became ill (42.2%). Condom use with women in all episodes of sexual intercourse before HIV+ diagnosis was reported by 22.6% of heterosexuals and 34.7% of bisexuals (P < 0.05). With respect to drug use, 58.0% reported the use of drugs at some period in their lifetime. A higher proportion of individuals who had used drugs perceived themselves at risk (P < 0.05). Findings showed that most HIV+ men who have sex with women, regardless of sexual orientation or injecting drug use, did not use condoms and did not perceive themselves at risk before learning of their HIV+ status, and only undergo testing due to illness. The implications for heterosexual transmission of HIV are discussed.

The role of sexually transmitted diseases in HIV transmission.

More than 42 million people worldwide are now infected with HIV, in spite of sustained prevention activities. Although the spread of HIV has been primarily sexual, epidemiological studies have indicated that the efficiency of the spread of HIV is poor, perhaps as infrequently as 1 in every 1,000 episodes of sexual intercourse. However, sexually transmitted diseases (STDs) that cause ulcers or inflammation greatly increase the efficiency of HIV transmission--by increasing both the infectiousness of, and the susceptibility to HIV infection. STDs might be particularly important in the early stages of a localized HIV epidemic, when people with risky sexual behaviour are most likely to become infected. In China, eastern Europe and Russia, there has been a remarkable increase in the incidence of STDs in recent years, and this is reflected in the rapid increase in the spread of HIV in these areas. Targeted STD detection and treatment should have a central role in HIV prevention in these emerging epidemics.

The role of mother–daughter sexual risk communication in reducing sexual risk behaviors among urban adolescent females: a prospective study

Purpose To prospectively examine the relationship between mother–daughter communication about sex and selected sexual risk behaviors among inner-city adolescent females. Methods Participants were 219 sexually experienced females, 12 to 19 years of age, recruited from an inner-city adolescent medicine clinic in Philadelphia, PA, and randomly assigned to the control group of an HIV-risk reduction intervention study. Analyses were limited to data from control group participants to avoid confounding intervention effects. Poisson regression was employed to model three self-reported sexual risk behaviors: number of male sexual partners, number of episodes of sexual intercourse, and number of episodes of unprotected intercourse. Mediation effects were evaluated using variables from the Theory of Planned Behavior. Data were analyzed using Poisson regression. Results Higher levels of mother–daughter sexual risk communication were associated with fewer episodes of sexual intercourse and unprotected intercourse at 3-month follow-up. There was evidence that the relationship of communication to unprotected intercourse was mediated by condom use self-efficacy. Mother–daughter sexual risk communication was not significantly associated with adolescents’ reports of numbers of male sexual partner. Conclusions This prospective study supports the notion that mothers who communicate with their daughters about sex can affect their daughters’ sexual behaviors in positive ways. These findings lend support for the design and implementation of family-based approaches to improve parent–adolescent sexual risk communication as one means of reducing HIV-related sexual risk behaviors among inner-city adolescent females.

Sexual activity and plasma testosterone levels in hypertensive males

The aim of this study was to compare sexual activity and plasma testosterone levels of hypertensive men with those of healthy normotensive controls. We investigated 110 newly diagnosed, never treated hypertensive (blood pressure [BP] ≥140/95 mm Hg) men and 110 healthy normotensive (diastolic BP <90 mm Hg) men. All of them were aged 40 to 49 years, married, without any previous sexual dysfunction, nondiabetic, nonobese (body mass index <28 kg/m 2), nonsmoking, and not taking any drug. All subjects were evaluated in the morning after an overnight fast. Clinical evaluation included BP, body weight, and height measurements, determination of testosterone, and an interview about sexual activity, assessed as number of sexual intercourse episodes per month. Hypertensive men presented a 25% reduction in sexual activity as compared to normotensive men (5.9 ± 2.6 v 7.9 ± 2.5 sexual intercourse episodes per month, respectively, P < .01) and a 12% reduction in testosterone levels (510.6 ± 151.9 ng/dL v 578.6 ± 146.8 ng/dL, P < .01). In both normotensive and hypertensive men Pearson’s correlation analysis showed a significant positive correlation between testosterone levels and sexual activity and a significant negative correlation between testosterone and age and between testosterone and BP values. Multiple regression analysis confirmed a significant inverse relationship between testosterone and age in normotensive men, whereas only a nonsignificant trend was found in the hypertensive ones. In addition, a significant inverse correlation between testosterone and BP levels was confirmed in hypertensive men limited to systolic BP, whereas a nonsignificant trend was observed in the normotensive controls. In conclusion, these findings suggest a relationship between essential hypertension and impaired testosterone levels in men. The elucidation of the nature of such a relationship and its physiologic and clinical significance needs further investigation.

A Comparison of the Risk Characteristics of Ever-Pregnant and Never-Pregnant SexuallyActive Adolescents

Abstract This article describes the risk behaviors of a sample of sexually active, urban African American adolescent females, and examines the differences between adolescents who havebeen pregnant (ever-pregnant) and adolescents who have not been pregnant (never-pregnant). Of the 279 young women interviewed, 48% had a history of pregnancy. Logistic regression indicated that adolescents who had a history of pregnancy engaged in higher-risk behaviors than their non-pregnant peers. Adolescents who had been pregnant were more likely to have multiple sexual partners, more likely to have had sex under the influence of drugs, and more likely to have had an STD. These adolescents also were less likely to have used a condom during their last episode of sexual intercourse and less likely to use condoms every time they have sex. Our results suggest that a history of pregnancy is associated with higher-risk sexual behaviors. Moreover, for many young women, the experience of getting pregnant does not appear to decreas...

Decision-making in adolescent sexuality

BACKGROUND: In light of the social and public health consequences of at-risk sexual behavior for adolescents, a great need exists to understand adolescent sexual and reproductive decision-making. Further information can guide medical professionals in the intervention and counseling of this at-risk population. The main objective of this preliminary study is to survey female adolescent gynecological patients about their sexual experiences via questionnaire. Our forty-three question survey focuses on concerns regarding adolescent sexuality: 1) Is there a correlation between features of the first episode of sexual intercourse and future at-risk sexual behavior and decision-making? 2) Is any decision-making involved before adolescents decide to become sexually active? 3) If adolescents decide to postpone sexual intercourse, are they engaging in other at-risk sexual activities?METHODS: Seventy-two (72) female patients aged 12 to 20 years who presented for routine pediatric/adolescent gynecological care and met inclusion criteria were recruited from St. Louis Children's Hospital Pediatric Subspecialty Clinic. Parental consent for minors and patient consent for participants 18-20 years was obtained prior to completion of the anonymous, self-administered surveys in accordance with the Human Studies Committee at Washington University. The data was analyzed with SPSS Windows.RESULTS: The mean age of the participants was 16.01 years (standard deviation 1.72). Demographically, 20.3% were African-American and 75% were Caucasian. Although 44.4% (32/72) had engaged in sexual intercourse, many surveyed adolescents were engaging in other sexual activities before sexual intercourse: 57.5% of “virgins” described breast stimulation; 45% described vaginal stimulation; 22.5% described engaging in cunnilingus; 27.5% described penile stimulation; and 17.5% described engaging in fellatio. There appeared to be racial differences in oral sex participation. African American girls surveyed were significantly less likely to engage in oral sex before sexual intercourse (p = .026). Only 22.2% of surveyed adolescents denied participation in any sexual experiences. Of all participants who had engaged in sexual intercourse, there appeared to be little decision-making. 46.9% indicated that “it just happened” and 28.1% indicated that they decided to have sex during intimacy. The majority of participants did not discuss birth control (68.8%) or STD's (56.3%) with their partner. This lack of discussion was correlated with failure to use an effective birth control method (p = .034) and risk for later contraction of an STD (p = .022)CONCLUSIONS: In this preliminary study, 78.8% of adolescent girls are participating in sexual activities whether or not they have engaged in intercourse. This study supports the hypothesis that clinicians need to be aware that adolescent patients, who deny being “sexually active”, may be engaging in higher-risk sexual activities including oral sex. More directed questions need to be asked to determine the level of sexual activity. Furthermore, 75.0% of the participants reported no discussion or advanced planning prior to their first coital episode. Inadequate decision-making coupled with inadequate communication about birth control and STD's was associated with poor outcomes including pregnancy and STD's.

Délivrance de la contraception d’urgence, en 1998, dans les centres de planification et d’éducation familiale (CPEF) du Val de Marne

Objectives – To facilitate access to emergency contraception (EC). To allow the nurses in the family planning clinics to deliver it during the doctor’s absence. Methods – For one year, 1998, 1102 women requested EC in the 38 family planning clinics participating in the study. This study evaluated the utilisers and the circumstances under which dispensation occurred. Results – The users of EC were young, 45 % under 18 years and 90 % under 25 years. There was a marked difference between the contraception the women declared they used and that which they actually did during their last episode of sexual intercourse. Women requested EC in case of condom breakage or slipping (49 %), forgotten pill (8 %), or after unprotected intercourse (43 %). Nurses personnaly received 809 requests for EC, and 293 women were received by the family planning doctor. In 77 % of the cases, EC was given by the nurses, and for the others after medical opinion. But only 7 % had a medical “problem” (contraindications to estrogen-progestin, or cycle disorder). Among the 823 women for whom information was obtained, 22 unwanted pregnancies were observed, 18 of these patients decided to have an abortion. 97.3 % efficacity. Conclusion – Making EC more easily available in family planning clinics with dispensation by nurses does no harm and may reduce the rate of unwanted pregnancy.

Sexual activity in hypertensive men treated with valsartan or carvedilol: a crossover study

The aim of this study was to compare the effect of antihypertensive treatment with valsartan or cavedilol on sexual activity in hypertensive men who were never treated for hypertension. A total of 160 newly diagnosed hypertensive men (diastolic blood pressure [DBP] ≥ 95 mm Hg and < 110 mm Hg), aged 40 to 49 years, all married and without any previous sexual disfunction, were enrolled. After a 4-week placebo period, the patients were divided into two groups: a) 120 patients were randomized to receive carvedilol 50 mg once daily or valsartan 80 mg once daily for 16 weeks according to a double-blind, cross-over design; after another 4-week placebo period, patients were crossed over to the alternative regimen for a further 16 weeks; b) 40 patients were treated with placebo according to a single-blind design for 16 weeks. At the screening visit and every 4 weeks thereafter, blood pressure (BP) was evaluated and patients were interviewed by a questionnaire about their sexual activity. Blood pressure was significantly lowered by both treatments, with a 48% of normalization with valsartan and 45% with carvedilol. During the first month of therapy, sexual activity (assessed as number of sexual intercourse episodes per month) declined with both drugs as compared with baseline, although the decrease was statistically significant in the carvedilol (from 8.2 to 4.4 sexual intercourse episodes, P < .01) but not in the valsartan-treated patients (from 8.3 to 6.6 sexual intercourse episodes, not significant). Ongoing with the treatment the sexual activity further worsened with carvedilol (3.7 sexual intercourse episodes per month) while fully recovered and also improved with valsartan (10.2 sexual intercourse episodes per month). The results were confirmed by the cross-over. Erectile dysfunction was a complaint of 15 patients with carvedilol (13.5%), one patient with valsartan (0.9%), and one patient in the placebo group. These findings suggest that carvedilol induces a chronic worsening of sexual activity, whereas valsartan not only does not significantly worsen sexual activity but may even improve it.

“Primary” versus “secondary” vulvar vestibulitis: One disease, two variants

Objective: Our aim was to determine whether women with primary vestibulitis—since the first episode of sexual intercourse—differ in disease characteristics and outcome of operative treatment from women with secondary vestibulitis. Study Design: A total of 111 patients with severe vulvar vestibulitis underwent perineoplasty from 1991 to 1995. Thirty-nine (35%) of them had primary vestibulitis (ie, dyspareunia from the first attempt at sexual intercourse). They were compared with 72 (65%) who had secondary vestibulitis with regard to demographic, social, and medical variables, the presence of human papillomavirus deoxyribonucleic acid, physical and histopathologic findings in the vestibule, and surgical outcome. Results: Women with primary vestibulitis were 5 years younger than those who had secondary vestibulitis (22.9 ± 2.9 years vs 27.7 ± 8.6 years, respectively; P <.0001) and differed in their marital status (unmarried, 84% vs 56%, respectively; P <.008), parity (nulliparous, 97% vs 67%, respectively; P <.0002), and involvement of the whole vestibule (74% vs 93%, respectively; P <.006). The 2 groups were similar in all other variables, including use of oral contraception, smoking, presence of human papillomavirus, dysuria, success of perineoplasty (average, 83%), and histopathologic findings. Conclusions: Women with primary vestibulitis were younger than women with secondary vestibulitis. Most other differences were dependent on the different ages of the 2 groups. Primary and secondary vestibulitis may therefore be two presentations of the same disease. (Am J Obstet Gynecol 2001;184:28-31.)

Unprotected sex as a function of alcohol and marijuana use among adolescent detainees

Purpose: To examine the relationship between the use of two substances (alcohol and marijuana) and the occurrence of unprotected sexual intercourse among adolescent detainees. Methods: Participants were asked about their use of alcohol, marijuana, and condoms. In addition to comparing levels of alcohol and marijuana use, the study examined relationships among the following variables: (a) the number of days that each substance was used and the number of unprotected episodes of sexual intercourse in the 30 days preceding admission to a youth detention center; (b) the number of times that each substance was used before or during sexual intercourse and the number of unprotected episodes in the same time period; (c) the use of each substance and unprotected intercourse at the last sexual episode; and (d) intentions to use each substance in the context of sex and to have unprotected intercourse in the future. Relationships among these variables were assessed in four regression models, each of which included participants’ demographic characteristics, AIDS knowledge, attitudes toward condoms, and future orientation as covariates. Results: Results of all four regression models indicated that marijuana use was associated with unprotected sexual intercourse. Adolescents who used more marijuana in general as well as specifically in sexual episodes in the 30 days preceding detention reported higher levels of unprotected sex. In addition, marijuana use in the last episode was related to the occurrence of unprotected sex during that episode. Moreover, intentions to use marijuana in future sexual episodes was associated with intentions to have unprotected intercourse in the future. Conclusions: Future studies should use more rigorous research designs to clarify the nature of the relationship between marijuana use and risky sex.

Are adolescents being screened for sexually transmitted diseases?

To determine the proportion of sexually experienced African American adolescents who report having been screened for sexually transmitted diseases and to determine the proportion who report having been screened for these diseases among adolescents who have had a preventive primary health care visit in the past 2 years. A telephone survey of a population-based sample of African American adolescents aged 12 to 17 years residing in a low-income neighborhood in San Francisco with a high prevalence of sexually transmitted diseases. Of the 302 adolescents surveyed, 118 (39.1%) reported a history of sexual intercourse. Of these, 17 (26. 2%) of 65 males and 31 (58.5%) of 53 females had been screened for a sexually transmitted disease in the previous 12 months. Twenty (30. 8%) of the males and 32 (60.4%) of the females had been screened for a sexually transmitted disease in the previous 24 months. Of the 93 participants who had a preventive primary care visit since their first episode of sexual intercourse, 14 (26.4%) of the 53 males and 24 (60.0%) of the 40 females had been screened for a sexually transmitted disease in the previous 24 months. Sexually experienced African American adolescents in San Francisco are being screened for sexually transmitted diseases at rates well below those recommended by current clinical guidelines. A low rate of screening was found even in adolescents who had been seen for a preventive primary care visit since they had first had sex. This suggests that the preventive primary care visit is not being used to its full potential as an opportunity to screen and treat adolescents for sexually transmitted diseases. Capitalizing on this opportunity to screen may increase the number of cases of sexually transmitted diseases diagnosed and, thus, decrease rates of these diseases in this population.

Are adolescents being screened for sexually transmitted diseases? A study of low income African American adolescents in San Francisco

Objectives: To determine the proportion of sexually experienced African American adolescents who report having been screened for sexually transmitted diseased (STDs), and to determine the proportion who report having been...

Integrating HIV prevention education into existing family planning services: results of a controlled trial of a community-level intervention for young adults in rural China.

Young adults in China are at increasing risk for HIV infection, yet there have been few prevention programs to address this growing public health problem. In 1996–1997, we conducted a community-based AIDS prevention intervention in semirural Kunshan county near Shanghai, which was integrated into an existing family planning network. We recruited 748 study participants aged 18–30 years from two townships similar in their socioeconomic characteristics. The experimental township received a multifaceted 12-month intervention that included written materials, videos, radio programs, small group discussions, home visits, individual counseling, and a free supply of condoms. Data from both townships were collected at baseline and at 12-month follow-up. Among intervention participants, AIDS-related knowledge and attitudes improved significantly. Intervention participants also reported an increase in condom use during the last episode of sexual intercourse from 9% at baseline to 14% at follow-up, while those using condoms as their main contraceptive method increased from 4% to 10% (both p < .05); no such increases occurred among control subjects. This study demonstrates the feasibility of integrating an HIV prevention intervention into an existing family planning services network. Integrating services in this manner may be an approach to a sustainable AIDS intervention in similar settings where reproductive health services are already established.

Sexual function in hypertensive males treated with lisinopril or atenolol: A cross-over study

To evaluate the effect of antihypertensive treatment on sexual activity, 90 hypertensive men, aged 40 to 49 years, all married and without history of sexual dysfunction were treated with 100 mg of atenolol or 20 mg of lisinopril for 16 weeks, according to a double-blind, randomized, cross-over design. During the first month of therapy, sexual activity, assessed as number of sexual intercourse episodes per month, significantly declined with both atenolol (from 7.8 ± 4.3 to 4.5 ± 2.8, P < .01 v placebo) and lisinopril (from 7.1 ± 4.0 to 5.0 ± 2.5, P < .05 v placebo). Ongoing with the treatment, sexual activity tended toward recovery in the lisinopril (7.7 ± 4.0 sexual intercourse episodes per month, P = NS v placebo), but not in the atenolol group (4.2 ± 2.8, P < .01 v placebo), with a statistically significant difference between the two drugs ( P < .01). The percentage of patients who complained of sexual dysfunction symptoms was significantly higher in the atenolol- than in the lisinopril-treated group (17% v 3%, P < .05). These findings suggest that atenolol induces a chronic worsening of sexual activity, whereas lisinopril causes only a temporary decline.

An empirical operationalization study of DSM-IV diagnostic criteria for premature ejaculation

The DSM-IV diagnostic criteria for premature ejaculation remain to be investigated by a clinical study. A prospective study was therefore conducted to investigate the DSM-IV definition and to provide an empirical operationalization of premature ejaculation. In this study 140 men suffering from lifelong premature ejaculation were interviewed separately from their partners. Various means of assessing the intravaginal ejaculation latency time (IELT) were compared: assessment by spontaneous answer, by questionnaire, by imagining foreplay and intercourse and estimating the ejaculation time without a clock or with a clock, and by stop-watch measurement at home over a one-month period. The number of thrusts and feelings of control during foreplay and intercourse were also assessed. A total of 110 men used the stop-watch method. Ninety percent of all the subjects ejaculated within one minute of intromission, with 80% actually ejaculating within 30 seconds. The age of the men and duration of their relationship were not correlated with IELT; however, the IELT tended to be longer for couples who had a higher frequency of intercourse. There was only a moderate correlation between the various methods of assessing IELT. The results suggest that premature ejaculation could be operationally defined as an IELT < 1 min in more than 90% of episodes of sexual intercourse, independent of age and duration of relationship.

Meanings assigned by undergraduates to frequency statements of condom use.

Studies of condom use must rely upon self-report data which may not be reliable and valid. This investigation examined how 192 undergraduates (17-48 years) interpret response categories (never, rarely, sometimes, most of the time, always) used in some surveys to assess frequency of condom use. Subjects completed a questionnaire that described a scenario of a couple who had engaged in sexual intercourse 20 times during the past 3 months. As part of the survey, there were 21 statements in which the stated number of times condoms were used varied from 0 to 20 (e.g., condoms were used 18 out of the 20 episodes of sexual intercourse). For each statement, subjects were instructed to circle the category they believed best matched the frequency with which condoms had been used: 31% indicated that using condoms 1 out of 20 times was an example of never using condoms; similarly, 23% indicated that using condoms 2 times out of the 20 encounters was an example of never using condoms, 40% indicated that condom use for 19 out of 20 encounters was always using condoms, whereas 23% applied the always label to condom use for 18 out of 20 encounters. These results generally support the validity of this type of condom use measurement, but suggest that caution is needed in interpretation. Implications of these findings are discussed with respect to health messages and research methodology.

Reasons for not using condoms of clients at urban sexually transmitted diseases clinics.

Greater understanding of the factors related to inconsistent condom use is essential in the development of strategies to promote condom use among clients who access public, inner-city sexually transmitted diseases (STD) clinics. Therefore, this study aimed to explore reasons for not using condoms among 260 predominantly African American heterosexual male and female clients presenting for care at two inner-city STD clinics. Clients selected for this descriptive analysis reported having had at least one unprotected episode of sexual intercourse in the last 10 episodes. In face-to-face interviews, clients provided information about sexual activity, sexual partners, and condom use in the previous 30 days. In addition, they were asked to indicate the main reason for not using condoms when having unprotected sex. Content analysis showed six major categories of reasons for not using condoms: reasons related to partner relationships, reasons related to sexual sensation, reasons related to situational constraint, reasons related to condoms themselves, reasons related to pregnancy, and reasons related to types of sexual activity. Most frequent explanations given for not using condoms included partner trust (19.6%), the feel of condoms (11.9%), and lack of condom availability (11.5%). Clients also reported barriers to condom use that included beliefs about condom sensation and partner relationships. These results show the continued barriers that exist with respect to condom use in at-risk populations and emphasize the need to tailor meaningful interventions in order to promote condom use among persons who, for differing reasons, choose not to use them.

HIV risk behavior among Peace Corps Volunteers

To describe HIV risk behaviors among Peace Corps Volunteers (PCV) and to examine correlates of sexual risk behaviors. Cross-sectional data were collected from 1242 randomly selected PCV serving in 28 countries in 1991. PCV reported the frequency of specific risk behaviors in self-administered questionnaires, which were completed anonymously and returned to the Centers for Disease Control and Prevention. Non-sexual HIV risk behaviors were rarely reported by PCV. Sixty-one per cent of the 1080 PCV who answered questions about sexual behavior during their Peace Corps service reported having at least one sex partner. Sixty per cent of PCV had another PCV partner, 39% had a host-country national partner, and 29% had a non-PCV expatriate partner. Overall, less than one-third (32%) of unmarried PCV used condoms during every episode of sexual intercourse; more frequent use was reported in relationships with non-steady and (for male PCV) host-country national partners. Among male PCV, condom use was positively related to lower alcohol use and the belief that HIV was a problem in the host country. Female PCV reporting more condom use with male partners were younger and had fewer partners than those reporting less use. These data indicate that PCV are at risk for acquiring HIV through unprotected vaginal intercourse. All persons who become sexually active with new partners while travelling or living abroad should be encouraged to use condoms consistently.

Factors explaining intent, discussion and use of condoms in first-time sexual encounters

A 1990 Centers for Disease Control seroprevalence study conducted on 19 university campuses found 1/500 college students to be seropositive for HIV. Regular condom use among college women has however increased from 12% in 1975 to 21% in 1986 to 41% in 1989. The authors hypothesize and test the notion that individuals approach an episode of sexual intercourse with some predispositions about condoms; some who want to use condoms may initiate discussion of the topic with the partner; and a condom may or may not ultimately be used depending upon discussion about use and availability. 74 male 128 female and 2 other college students aged 18-32 in a large eastern metropolitan area completed a 14-page questionnaire as participants in the study. 90% of respondents were sophomores juniors and seniors aged 18-22 and all had had intercourse with at least 1 new partner of the opposite sex in the preceding 12 months. 43% had used a condom at most recent intercourse with the new partner. 32% reported having 10 or more sex partners in their lifetime; 18% had had 5 or more partners in the past year; and 36% had not used a condom the 1st time with any of their sexual partners in the 1st year yet 69% felt at no or very low risk of being exposed to HIV. Discriminator variables include AIDS saliency assessment of AIDS risk alcohol/drug use condom use self-efficacy communication self-efficacy erotophobia/erotophilia health locus of control length of relationship risky behavior and self-esteem. The evidence supports the 3-stage model. Moreover erotophobia/erotophilia and assessment of AIDS risk best discriminate between those who wanted to use condoms and those who did not; communication self-efficacy alcohol/drug use external locus of control and erotophobia/erotophilia were the most important discriminators for the communication stage; and condom self-efficacy risky behavior and self-esteem were the most important discriminators for actual condom use. It should be noted that individuals reporting higher levels of previous risky behavior were more likely to report using condoms.

Evidence of marked sexual behavior change associated with low HIV-1 seroconversion in 149 married couples with discordant HIV-1 serostatus

To determine the effect of an HIV-1 counselling program on 149 married Zairian couples with discordant HIV-1 serology, the rates of HIV-1 seroconversion and reported condom utilization have been observed during 382.4 person-years of follow-up (minimum follow-up time per couple of 6 months). Before determination of HIV-1 serostatus and counselling, less than 5% of these couples had ever used a condom. One month after notification of HIV-1 serostatus and counselling, 70.7% of couples reported using condoms during all episodes of sexual intercourse. At 18 months follow-up, 77.4% of the 140 couples still being followed reported continued use of condoms during all episodes of sexual intercourse. At the time of notification of HIV-1 serostatus, 18 couples experienced acute psychological distress. Home-based counselling by trained nurses resolved these difficulties in all but three couples who subsequently divorced. Intensive counselling following notification of HIV-1 serostatus led to low rates of HIV-1 seroconversion (3.1% per 100 person-years of observation) in Zairian married couples with discordant HIV-1 serostatus who voluntarily attended an HIV counselling center.