Lifetime Sexual Partners Research Articles

School-Level Poverty and Rurality Associated With Differences in Sexual Risk Behaviors Among U.S. Public High School Students

PurposeThis study examined associations between student sexual behaviors and both school-level socioeconomic status and metropolitan status. MethodsNational Youth Risk Behavior Survey data from 2017 (N = 14,765, response rate = 60%) and 2019 (N = 13,677, 60%) were combined. School-level socioeconomic status (low-, mid-, and high-poverty based on the percentage of students eligible for free or reduced-price meals) and metropolitan status (urban, suburban/town, or rural) were identified for students attending public high schools. Sexual behaviors included currently sexually active, four or more lifetime sexual partners, condom use during the last sexual intercourse, hormonal birth control use during the last sexual intercourse, condom and hormonal birth control use during the last sexual intercourse, and drank alcohol or used drugs before the last sexual intercourse. Adjusted prevalence ratios were calculated using logistic regression models, controlling for sex, race/ethnicity, and grade. ResultsCompared to students attending low-poverty schools, high-poverty school students were significantly more likely to be currently sexually active (adjusted prevalence ratio = 1.4 [95% confidence interval = 1.1–1.8]) and have four or more lifetime sexual partners (1.6 [1.0–2.5]), but were significantly less likely to have drank alcohol or used drugs before the last sexual intercourse (.7 [.5–.9]) and have used hormonal birth control during the last sexual intercourse (.7 [.6–1.0]). Compared to students attending rural schools, urban school students were significantly less likely to be currently sexually active (.8 [.7–.9]) and have four or more lifetime sexual partners (.7 [.5–.9]). ConclusionsSchool-level socioeconomic status and metropolitan status were associated with differential risk in sexual behaviors.

Risk Factors for HIV sero-conversion in a high incidence cohort of men who have sex with men and transgender women in Bangkok, Thailand.

BackgroundWe measured Human Immunodeficiency (HIV) incidence, retention, and assessed risk factors for seroconversion among two previously unreported cohorts of men who have sex with men (MSM) and Transgender Women (TGW) in Bangkok, Thailand between 2017 and 2019.MethodsWe conducted an 18-month prospective cohort study of HIV-uninfected Thai cisgender men and TGW aged between 18 and 35 years who reported sex with men in the past six months and at least one additional risk factor for HIV infection. HIV and syphilis testing and computer-based behavioral questionnaires were administered at each visit. We utilized Poisson regression to calculate HIV incidence rates. A survival random forest model identified the most predictive risk factors for HIV sero-conversion and then used in a survival regression tree model to elucidate hazard ratios for individuals with groups of selected risk factors. Cox proportional hazards (pH) regression evaluated the strength of association between individual covariates and risk of sero-conversion.FindingsFrom April 2017-October 2019, 1,184 participants were screened, 167 were found ineligible, and 1,017 enrolled. Over the 18-month study, visit retention was 93·4% (95% CI 91·6%–94·8%) and HIV incidence was 3·73 per 100 person-years (95% CI 2·79–5·87). Utilizing survival regression tree modeling, those who were 18–20 years of age, reported sexual attraction to mostly or only men, and had five or more lifetime sexual partners were 4·9 times more likely to seroconvert compared to other cohort participants. Factors associated with HIV incidence utilizing Cox pH regression included sexual attraction to mostly or only men (adjusted hazard ratio (aHR) 14·9 (95% CI 20·1–107·9), younger age (18–19 years, aHR 10·88 (95% CI 4·12–28·7), five or greater lifetime sexual partners (aHR 2·0, 95%CI 1·1–3·6), inconsistent condom use with casual partners (aHR 2·43, 95% CI 1·3–4·5), and prior HIV testing (adjusted HR 2·0, 95% CI 1·1–3·5).InterpretationInterpretation HIV incidence remains high among Bangkok-based MSM and TGW. These key populations expressed high interest in participating in efficacy evaluation of future prevention strategies and had high retention in this 18 month study.FundingFunding US National Institute of Allergy and Infectious Diseases (NIAID), Division of AIDS Interagency Agreements (DAIDS) and U.S. Department of the Army.

Human papillomavirus prevalence and risk factors among Australian women 9–12 years after vaccine program introduction

BackgroundIn Australia, high and widespread uptake of the quadrivalent human papillomavirus (HPV) vaccine has led to substantial population-level reductions in the prevalence of quadrivalent vaccine targeted HPV genotypes 6/11/16/18 in women aged ≤ 35 years. We assessed risk factors for HPV detection among 18–35 year old women, 9–12 years after vaccine program introduction. MethodsWomen attending health services between 2015 and 2018 provided a self-collected vaginal specimen for HPV genotyping (Roche Linear Array) and completed a questionnaire. HPV vaccination status was validated against the National Register. Adjusted odds ratios (aORs) and 95% confidence intervals (CI) were calculated for factors associated with HPV detection. ResultsAmong 1564 women (median age 24 years; IQR 21–27 years), Register-confirmed ≥ 1-dose vaccine coverage was highest at 69.3% and 68.1% among women aged 18–21 and 22–24 years respectively, decreasing to 42.9% among those aged 30–35 years. Overall prevalence of quadrivalent vaccine-targeted HPV types was very low (2.0%; 95% CI: 1.4–2.8%) and influenced only by vaccination status (5.5% among unvaccinated compared with 0.7% among vaccinated women; aOR = 0.13 (95% CI: 0.05–0.30)). Prevalence of remaining HPV types, at 40.4% (95% CI: 38.0–42.9%), was influenced by established risk factors for HPV infection; younger age-group (p-trend < 0.001), more recent (p < 0.001) and lifetime sexual partners (p-trend < 0.001), but not vaccination status. Prevalence of HPV31/33/45, which shared risk factors with that of non-vaccine targeted HPV types, was also lower among vaccinated (4%) compared with unvaccinated (7%) women (aOR = 0.51; 95% CI: 0.29–0.89), indicative of cross-protection. ConclusionVaccination has changed the epidemiology of HPV infection in Australian women, having markedly reduced the prevalence of vaccine-targeted types, including amongst women with known risk factors for infection. Vaccinated women appear to be benefiting from modest cross-protection against types 31/33/45 afforded by the quadrivalent HPV vaccine. These results reinforce the importance of HPV vaccination.

Risk factors for precancerous cervical lesion among women screened for cervical cancer in south Ethiopia: Unmatched case-control study.

BackgroundNearly 90% of deaths from cervical cancer occur in a low resource setting. In Ethiopia, the magnitude of precancerous cervical lesions ranges from 7% to 28%. Precancerous cervical lesions may progress to cervical cancer. Early screening and treatment of precancerous cervical lesions is a cost-effective way to avert the growth of cervical cancer. However, there has been limited research on risk factors for precancerous cervical lesions in Ethiopia. Therefore, this study aimed to identify risk factors for precancerous cervical lesions among women screened for cervical cancer in south Ethiopia.MethodA facility-based unmatched case-control study was carried out in five health facilities in south Ethiopia between 8 May to 28 September 2018. Interviewer administered questionnaires were used to collect data from 98 cases and 197 controls. Multivariate logistic regression was employed to identify determinants of precancerous cervical lesions.ResultsWomen aged 30–39 years (AOR = 2.51, 95% CI: 1.03–6.08), monthly income ≤66 (AOR = 3.51, 95% CI: 1.77–6.97), initiation of first sexual intercourse at age less than or equal to 20 (AOR = 2.39, 95% CI: 1.14–5.47), having more than one lifetime sexual partner (AOR = 4.70, 95% CI: 2.02–10.95), having a partner/ husband with more than one lifetime sexual partner (AOR = 2.98, 95% CI: 1.35–6.65) had higher odds of precancerous cervical lesions.Conclusion and recommendationStrategies to prevent precancerous cervical lesions should focus on modification of lifestyle and sexual behaviour. The findings of this study highlight several implications for policymakers: targeting older women for cervical cancer screening, addressing inequalities and education relating to risky sexual behaviour may reduce precancerous cervical lesions. Furthermore, future longitudinal studies are needed to assess the awareness of women about cervical cancer screening.

Sequential acquisition of human papillomavirus infection between genital and oral anatomic sites in males.

Oral human papillomavirus (HPV) is associated with increasing rates of HPV-associated oropharyngeal cancer (OPC) in men. Sequential infection from one site to another has been demonstrated at the cervix and anus. Thus, risk of an oral HPV infection after a genital infection of the same type in the HPV infection in men study was investigated. Samples from 3140 men enrolled in a longitudinal cohort were assessed for sequential genital to oral infection with one of nine HPV types (HPV 6, 11, 16, 18, 31, 33, 45, 52 and 58); and then also sequential, same-type oral to genital infection. Incidence rate ratios (IRRs) compared rates of oral HPV among men with and without prior genital infection of the same type. Risk of sequential HPV infections were assessed using Cox proportional hazards model. Incidence of an oral HPV infection was significantly higher among men with a prior genital infection of the same type for any of the 9 HPV types (IRR: 2.3; 95% CI: 1.7-3.0). Hazard ratio of a sequential genital to oral HPV infection was 2.3 (95% CI: 1.7-3.1) and 3.5 (95% CI: 1.9-6.4) for oral to genital infection. Both changed minimally after adjustment for age, country, circumcision, alcohol use, lifetime sexual partners and recent oral sex partners. HPV infections at one site could elevate risk of a subsequent genital or oral HPV infection of the same type in men, emphasizing the importance of vaccination to prevent all HPV infections.

Prospective cohort study of children exposed to hepatitis C virus through a pregnancy screening program

ObjectivesPorto Alegre, in south Brazil, has one of the highest hepatitis C virus (HCV) infection rates in the country (84.4 cases/100 000 in 2018). Prenatal screening of HCV, however, has not been routinely offered. MethodsA longitudinal study of pregnant women with HCV and their infants was conducted between January 2014 and December 2018. Screening for HCV antibodies was offered to all women delivering at the study tertiary institution. HCV RT-PCR was performed if the woman was seropositive. Infants were followed prospectively. ResultsAmong 18 953 pregnant women delivering infants during the study period, 17 810 were screened for HCV antibodies (93.9%) with 130 positive results (HCV seroprevalence 0.7%). HCV-RNA was detectable in 57/117 cases (48.7%). HCV viremia was associated with the use of injectable drugs (P = 0.03), inhaled/crack drug use (P = 0.02), having an HCV-seropositive partner, and ≥3 lifetime sexual partners (P < 0.01). Genotype 1 was most prevalent (68%) during pregnancy. Among 43 children with follow-up, six (13%) were HCV-infected (transmission rate 13.9%); 50% were infected with genotype 3. Two infants (33%) cleared their infection; the mothers had genetic polymorphisms associated with clearance. ConclusionHCV vertical transmission was high in the study population, with HCV infection during pregnancy being vastly underdiagnosed. Public health efforts must focus on this vulnerable population for disease prevention and early treatment.

The emergency contraceptive pill in Brazil: High usage rates but schooling differences persist

ObjectivesThis paper aims to analyze usage rates for the emergency contraceptive pill (ECP) among women living in the city of São Paulo and their associated factors. Study designA population based cross-sectional survey was conducted in 2015 with a probabilistic sample of 4,000 women aged 15 to 44 living in São Paulo, Brazil. Response rate for households was 75% and 77% for eligible women. Binary logistic regression models were used to describe the association between each outcome and selected variables. ResultsA total of 51.4% of women living in the city of São Paulo had used ECP at least once in their lifetime. Women under 35 were more likely to use ECP, as were those with more than 9 years of schooling, having at least one live birth, not cohabiting with a partner, with more than two lifetime sexual partners and as length of sexual life decreased. Among ECP users, 32.6% used it only once, 47.5% used it 2 to 4 times, and 19.9% used it 5 or more times. ConclusionsOur findings suggest that ECPs have been incorporated into the contraceptive method mix for many women as a fundamental strategy for regulating fertility. Particularly young women, unmarried women and those who have had more partners seem to take greater advantage of ECP to prevent pregnancy. ImplicationsDespite the high use rate, lower levels of schooling are associated with lower levels of ECP use. There is a need for both policies to reduce schooling inequities and strategies to improve women's knowledge of reproduction and contraception.

Association of sexual behaviours and premature ejaculation

Premature ejaculation (PE) is the most common reported sexual complaint in men. It is believed that PE is associated with sexual behavior such as early sexual experience, novelty of partners or frequencies of intercourse. Therefore, to examine the association of PE and sexual behaviors in men, a case-control study was conducted with a total of 418 clients Subjects were interviewed for general health status, sexual behaviors, IELT and requested to complete the premature ejaculation diagnostic tool (PEDT). DSM-IV-TR criteria were applied for the diagnosis of PE. Those who diagnosed with PE(+) and PEDT score ≥ 11 belonged to the PE group; those diagnosed with PE(-) and PEDT &lt; 11 belonged to the non-PE group. The results indicated that no significant difference was noted regarding demographic features in the 2 groups. Normal men had a more frequent sexual life compared with PE patients (9.71 ± 6.09 and 6.62 ± 5.44 episodes of sexual intercourses per month, respectively with p &lt; 0.001. Subjects who were single or circumcised had higher prevalence of PE than married or uncircumcised men. Multivariable logistic analysis elucidated that circumcision, number of lifetime sexual partners and sexual frequencies were associated factors of PE. In conclusion, PE is a common sexual dysfunction in men. It was found to be significantly associated with circumcision and frequencies of sexual intercourse. Medical history taking of PE patients should include these sexual behavior factors.

Predictors of Bacterial Vaginosis among Pregnant Women Attending Antenatal Clinic at Tertiary Care Hospital in Tanzania: A Cross Sectional Study.

Background:Bacterial vaginosis (BV) is one of the most common genital tract infections in pregnancy associated with an increased risk of pregnancy losses, maternal and perinatal morbidity and mortality. Different social behavioural and obstetric factors can contribute to the development of BV. Determining the predictors of BV could be the best way of identifying women at high risk of developing the disease.Methods:This was a cross-sectional study conducted between December 2017 and February 2018 to determine the prevalence and predictors of BV among pregnant women attending antenatal Clinic (ANC) at Muhimbili National Hospital (MNH), Tanzania. Participants were recruited using systematic random sampling. For each consented participant, a pretested questionnaire was filled, a pelvic examination was done and a sample was collected. BV was diagnosed using Nugent's score. Data was analysed using Statistical Package for Social Scientists (SPSS) version 23.0. Bivariate and multivariate logistic regression analysis was done to determine factors that were independently associated with BV.Results:178 (26.7%) pregnant women out of 667 were diagnosed positive for BV. In the bivariate analysis (Table 3), age (COR 1.71; 95% CI, 1.16–2.52), level of education (COR 4.08, 95% CI, 2.84–5.84), gravidity (COR, 1.52, 95% CI; 1.04–2.23), parity (COR 1.69, 95% CI; 1.18–2.42), vaginal douching (COR 2.89, 95% CI; 1.96–4.27), HIV status (COR 9.37, 95%CI; 4.12–21.28), history of STI (COR 2.49 95% CI; 1.46–4.25), LTSP (COR 2.76, 95% CI; 1.68–4.54) and age of first coitus (COR 3.19, 95% CI; 2.24–4.56) were significantly associated with BV. After adjusting for confounders in multivariate analysis, the following risk factors remained significantly associated with BV; age of 21–29 years (AOR, 2.22, 95%CI; 1.45–3.49), primary education level (AOR 3.97, 95% CI; 2.63–5.98), vaginal douching (AOR 3.68, 95% CI; 2.35–5.76), HIV status (AOR 6.44, 95% CI; 2.62–15.88), STI infection (AOR 2.34, 95% CI; 1.25–4.37), more than one LTSP (AOR 2.69, 95% CI; 1.53–4.74) and age of less than 18 years of first coitus (AOR 2.16, 95% CI; 1.42–3.30).Conclusion:The prevalence of BV in pregnant women was found to be high. Age of less than 30 years, primary education level and below, vaginal douching, HIV infection, STI, more than one lifetime sexual partners and early age of sexual debut were found to be significant predictors of BV. The high prevalence of BV in our population should necessitate policy makers to include screening and treatment of BV in the future policy of antenatal care package, as BV is associated with significant maternal and neonatal morbidity and mortality. Women should also be educated on harmful effects of certain behavioural practices such as vaginal douching that predispose to BV. In addition symptoms of BV such as abnormal vaginal discharge during pregnancy are inconsistent, under reported and often overlooked. Therefore, a high-risk approach can be used for screening and treatment of asymptomatic women.

Prevalence and Risk Factors of Human Papillomavirus Infection among Japanese Female People: A Nationwide Epidemiological Survey by Self-Sampling.

Background:Nationwide epidemiological surveys of behavioral factors and human papillomavirus (HPV) infection among Japanese women are scarce. This study aimed to determine the prevalence, genotype distribution, and significant predictive factors of HPV infection using self-collected vaginal samples from Japanese female people. Methods:The study population consisted of 1,050 female subjects aged 16–75 years (median 30 years). The participants were asked to provide self-collected samples from the vaginal wall using cotton swabs for genotyping of HPV. We compared the participants’ characteristics and detected HPV genotypes to determine significant predictors of HPV infection. Results:After excluding 47 participants (34 participants of unknown age, 11 virgin participants, 1 participant who engaged in sex with another woman, and 1 participant who did not undergo β-globin detection), 1,003 participants were included in the analysis. Of the 1,003 participants, 426 (42.5%) participants had at least one HPV genotype, 282 (28.1%) participants had high-risk HPV genotypes, 306 (30.5%) had low-risk HPV genotypes, and 162 (16.2%) participants had both HPV genotypes. HPV-16/18 positivity was found in 5.4% (54/1,003) participants. The most frequently detected high-risk HPV genotype was HPV-52 (86/1,003; 8.6% participants). The number of lifetime sex partners (≥6) and a present history of sexually transmitted infection (STI) were significant predictors of high-risk HPV infection. The number of lifetime sex partners (≥6), age of coitarche (≥20 years of age), unmarried status, and a present history of STI were significant predictors of low-risk HPV infection. Conclusions:The prevalence of high-risk and low-risk HPV infection among Japanese female subjects was 28.1% and 30.5%, respectively. The number of lifetime sex partners (≥6) and present history of sexually transmitted infection were the common significant predictors of high-risk and low-risk HPV infection.

Health and Women’s Employment in Cameroon

Introduction: Housewives report more chronic illnesses than employed women and housewives are more likely to rate their health situation as either poor or fair than employed women. Poor health can deter a woman from seeking or keeping a job and this appears to be a major reason why poor health is reported more frequently by housewives than employed women.&#x0D; Purpose: This work investigated the influence health bears on women’s employment in Cameroon.&#x0D; Methodology: It utilized the expo-factor research design. Secondary data from the Demographic Health Survey (DHS) in Cameroon for 1991, 1998, 2004, 2011 and 2018 was also used in this work. The Instrumental Variable Probit Model and Control Function were used to analyze the data.&#x0D; Findings: Health capture by BMI had a negative and statistical significant effect on women’s employment. Other variables that positively and significantly influenced women employment were education, husband education, husband’s occupation, marital status, region of origin and lifetime sex partners on the one hand. On the other hand, the woman’s age, wealth levels, age at first birth, religion and year negatively and significantly affected the likelihood of her being employed. Factors that positively and significantly influenced women’s health were education, husband’s education, skipping meals and religion. In this vein, Muslims and Animists were significantly associated with lower BMI and better health compared to Catholics. On the other hand; age, husband’s occupation, lifetime sex partners, women’s employment, use of modern contraceptives, husband’s age, age at first birth, respondent’s occupation negatively and statistically significantly influenced women’s health. It was concluded that as women’s health worsens (BMI increase), the likelihood that they were employed reduced.&#x0D; Unique contribution to theory, practice and policy: This study recommends compulsory health insurance for all workers especially female workers and the effective implementation of the much talk of universal health coverage in Cameroon.

Prevalence and determinants of genital Chlamydia trachomatis among school-going, sexually experienced adolescents in urban and rural Indigenous regions of Panama

ObjectivesTo determine the prevalence and risk factors of genital Chlamydia trachomatis (CT) among school-going sexually experienced male and female adolescents in Panama.MethodsWe conducted two multisite cross-sectional studies using two-stage cluster...

Prevalence of Genital Human Papillomavirus by Age and Race/Ethnicity Among Males.

Genital and oral cancers are often caused by human papillomavirus (HPV) types that can be prevented through HPV vaccination. Since HPV is sexually transmitted, knowledge of penile prevalence of vaccine-type HPV among US males can help predict potential disparities in these cancers. This study examines penile HPV prevalence by age and race/ethnicity among males. This study was a secondary analysis of publicly available data from the National Health and Nutrition Examination Survey (NHANES). Using data from penile swab samples collected from males between 2013 and 2016, the prevalence of 4vHPV and 9vHPV vaccine types was examined across age groups and by race/ethnicity. Logistic regression models adjusting for demographics, sexual behavior, and circumcision were examined to determine whether associations remained after accounting for confounders. Among 2548 males evaluated, HPV infection prevalence differed by race/ethnicity, with Black males exhibiting a higher prevalence of HPV. Examination of 4vHPV type prevalence by age group showed that 18-26-year-old males had a lower prevalence than older age groups. After controlling for confounders, 4vHPV prevalence was only significantly elevated among 27-34-year-old males, those who were single, and males with ≥3 lifetime sex partners. In adjusted models, 9vHPV type prevalence remained elevated among Black males compared with White males. Variations in 9vHPV type prevalence between Black and White individuals indicate future disparities in HPV-related genital cancers may continue in the United States during the next decade. Revaccinating certain populations with the 9vHPV vaccine may be appropriate to help mitigate this.

On the Elimination of Infections Related to Oncogenic Human Papillomavirus: An Approach Using a Computational Network Model.

Cervical cancer is the fourth most common malignancy in women worldwide, although it is preventable with prophylactic HPV vaccination. HPV transmission-dynamic models can predict the potential for the global elimination of cervical cancer. The random network model is a new approach that allows individuals to be followed, and to implement a given vaccination policy according to their clinical records. We developed an HPV transmission-dynamic model on a lifetime sexual partners network based on individual contacts, also accounting for the sexual behavior of men who have sex with men (MSM). We analyzed the decline in the prevalence of HPV infection in a scenario of 75% and 90% coverage for both sexes. An important herd immunity effect for men and women was observed in the heterosexual network, even with 75% coverage. However, HPV infections are persistent in the MSM population, with sustained circulation of the virus among unvaccinated individuals. Coverage around 75% of both sexes would be necessary to eliminate HPV-related conditions in women within five decades. Nevertheless, the variation in the decline in infection in the long term between a vaccination coverage of 75% and 90% is relatively small, suggesting that reaching coverage of around 70–75% in the heterosexual network may be enough to confer high protection. Nevertheless, HPV elimination may be achieved if men’s coverage is strictly controlled. This accurate representation of HPV transmission demonstrates the need to maintain high HPV vaccination coverage, especially in men, for whom the cost-effectiveness of vaccination is questioned.

Factors Associated With HIV Testing Among High-School Girls in the U.S., 2015‒2017

Few studies have examined the factors associated with HIV testing, specifically among U.S. high-school girls. Investigators analyzed 2015 and 2017 Youth Risk Behavior Survey data to calculate the prevalence ratios and the corresponding 95% CIs for the association of HIV-related risk behaviors and other factors with HIV testing. Analyses were completed in March 2020. Approximately 1 in 10 high-school girls reported ever having had an HIV test. Ever having had an HIV test was most common among girls who had ≥4 lifetime sexual partners and those who had ever injected illegal drugs. High-school girls who engage in behaviors or experience other factors that put them at higher risk for HIV are more likely to have ever gotten tested. However, the prevalence of having ever had an HIV test remains relatively low, indicating that continued efforts may be warranted to reduce risk behaviors and increase testing among high-school girls.

Incidence and risk factors of C. trachomatis and N. gonorrhoeae among young women from the Western Cape, South Africa: The EVRI study

Young women in South Africa are highly affected by sexually transmitted infections (STI), like C. trachomatis (CT) and N. gonorrhoeae (NG). We aimed to estimate the incidence of CT and NG, and its determinants, among young women from the Western Cape, South Africa, participating in an HPV vaccine trial (the EVRI study). HIV-negative women aged 16-24 years were enrolled between October 2012 and July 2013. At enrolment and month 6 participants were screened for CT and NG (Anyplex CT/NG real-time detection method). A questionnaire on demographic and sexual history characteristics was completed at enrolment and month 7. Treatment for CT and/or NG was offered to infected participants. Incidence rates (IR) of CT and NG were estimated. Determinants of incident CT and NG infections were assessed using Poisson regression. 365 women were tested for CT and/or NG at least twice. Prevalence of CT and NG at baseline was 33.7% and 10.4%, respectively. Prevalence of co-infection with CT and NG was 7.1%. During 113.3 person-years (py), 48 incident CT infections were diagnosed (IR = 42.4 per 100 py, 95% confidence interval (CI) 31.9-56.2). Twenty-nine incident NG were diagnosed during 139.3 py (IR = 20.8 per 100 py, 95%CI 14.5-29.9). Prevalent CT infection at baseline was associated with incident CT (adjusted incidence rate ratio (aIRR) 5.8, 95%CI 3.0-11.23. More than three lifetime sex partners increased the risk for incident NG (3-4 partners aIRR = 7.3, 95%CI 2.1-26.0; ≥5 partners aIRR = 4.3, 95%CI 1.1-17.5). The IR of bacterial STIs among young women in the Western Cape is very high. Besides being previously infected and a higher lifetime number of sex partners, no other risk factors were found for CT and NG, suggesting that the majority of these women were at risk. This indicates the need for intensified prevention of STIs as well as screening and treatment programs to increase sexual health in this region.

Sexual Health Experiences Among High School Students With Disabilities

PurposeThe purpose of this study was to investigate the sexual experiences of adolescents with and without disabilities. MethodsData were from the 2015 and 2017 Oregon Healthy Teens survey, a state-wide representative sample of 11th grade students. We compared teens with and without disabilities on whether or not they had ever had sexual intercourse (N = 20,812). Among those who had ever had intercourse (N = 8,311), we used multivariable Poisson regression to measure the association between disability status and the prevalence of five sexual experiences. ResultsAfter adjusting for sociodemographic characteristics, the prevalence of ever having had intercourse was 25% higher among teens with disabilities than among those without (adjusted prevalence ratio [aPR] 1.25, 95% confidence interval [CI]: 1.20–1.30). Among students who had had intercourse, the prevalence of having had intercourse before the age of 15 years (aPR 1.25, 95% CI: 1.14–1.47), having ≥ 2 lifetime sexual partners (aPR 1.13, 95% CI 1.07–1.19), having ≥ 2 sexual partners in the previous three months (aPR 1.23, 95% CI: 1.00–1.52), having used alcohol and/or drugs at the last intercourse (aPR 1.28, 95% CI: 1.10–1.48), and having condomless sex at the last intercourse (aPR 1.17, 95% CI: 1.08–1.27) was higher among students with disabilities than among students without disabilities. After accounting for sexual abuse, each of these associations was attenuated and most were no longer significant. ConclusionsYouth with disabilities are sexually active. Findings highlight the need for increased attention to sexual abuse prevention, sexual health promotion, and risk reduction efforts for this population.

Who Are the Men Who Pay for Sex in Mozambique? Results from the National HIV/AIDS Indicator Survey 2015.

Mozambique has one of the highest burdens of HIV in the world, where the prevalence is estimated at 13.2% among adults aged 15-49 years. Men who pay for sex (MPS) are considered a bridging population for HIV infection. However, the characteristics of MPS in Mozambique are poorly understood. The objective of this study was to estimate the prevalence of paid sex among men 15-49years and investigate risk factors associated with paid sex. We analyzed data collected from 4724 men, aged 15-49years, as part of the 2015 Mozambique AIDS Indicator Survey. Chi-squared tests and logistic regression models accounting for survey design were used to assess the associations between paying for sex and demographic characteristics and the number of lifetime and recent sex partners, condom use at last sex, and self-reported sexually transmitted infection symptoms. The prevalence of paid sex in the last 12months was 10.4% (95% CI 9.0-12.1), with Cabo Delgado province having the highest prevalence (38.8%). MPS in the last 12months were most frequently between the ages of 20-24years (13.5%), not in a relationship (17.8%), had a primary education (11.9%), from poor households (14.0%), had more than three sexual partners excluding their spouse in the last 12months (44.7%), and self-reported a STI in the past 12months (44.2%). HIV prevalence was higher among men who ever paid for sex compared with men who did not (13.1% vs. 9.4%, p = .02). Men who reported 10+ lifetime partner (aOR 7.7; 95% CI 4.5-13.0; p < .001), from Cabo Delgado (aOR 4.0; 95% CI 2.2-7.4; p < .001), who reported STI symptoms in the past 12months (aOR 2.7; 95% CI 1.7-4.2; p < .001), and HIV positive (aOR 1.6; 95% CI 1.0-3.7; p = .05) were more likely to have paid for sex in the last 12months. These findings present the HIV prevalence among Mozambican MPS and highlight the need for a comprehensive behavioral, structural, and biomedical approach to interventions to reduce the risks of commercial and transactional sex.

HIV among women: does education matter more than we previously thought?

Women remain disproportionately affected by HIV in sub-Saharan Africa. Although there is unanimous agreement on the positive impact of schooling in reducing the pandemic, measuring the extent of this impact remains empirically difficult. Using data from the 2018 round of Zambia’s Demographic and Health Survey (DHS), we took advantage of the free primary education reform that abolished school fees for grades one to six in 2002 to obtain an exogenous variation in women’s education levels. We estimate a three-equation model to assess consistent estimates of the impact of education on a woman’s probability to be HIV positive. When the problems of sample selection and endogeneity are not addressed, we find that the effect of education on HIV status is greatly underestimated. After controlling for these two sources of bias, the effect having a secondary education on the risk of being seropositive doubles when compared to the uncorrected results. This result suggests that women acquire agency through education to prevent HIV infection. Pathways to these effects include contraceptive use, the number of lifetime sexual partners and marital status. Hence, policy makers and practitioners in Zambia should invest substantial efforts in promoting girls’ education in order to reduce the prevalence of HIV/AIDS among women.

Sexual Behavior Among US Adults: New Sex Partners and Number of Lifetime Sex Partners, NHANES 2013–2016 and NSFG 2011–2015

Sexual behavior information can provide context for understanding rates of sexually transmitted infections (STI) and inform potential impact of interventions. We used 2013–2016 National Health and Nutrition Examination Survey (n = 4930) and 2011–2015 National Survey of Family Growth (n = 16,643) data from sexually experienced 20–44-year old US females and males to estimate the number of lifetime and past year partners and percent with a new past year partner overall and by marital status, in 5-year age groups. Group differences were qualitatively assessed. Estimates from both surveys were comparable. The median number of lifetime sex partners ranged from 4.2 to 5.2 across age groups among females and was higher among older (9.1) than younger (4.6) males, persons with a new past year partner than those without, and persons widowed/divorced/separated/never married than those married/living with partner. Percents with ≥ 2 past year partners and a new past year partner were highest in the youngest age group and lower with age. Percent with a new past year partner was 19–46 percentage points higher in persons widowed/divorced/separated/never married (range 21.7–56.4%) compared to persons married/living with partner (range 2.7–12.4%). In the USA, there are differences in sexual behaviors by gender, age, and marital status. The percent of adults with a new sex partner is lower with increasing age; however, a portion of all subgroups reported having had a new sex partner in the past year indicating some adults remain at risk of acquiring an STI. These data can help inform policies for STI screening and other interventions.