Sexually Transmitted Infections Infection Research Articles

Sexuality education and determinants of perceived sex refusal skills among Lebanese adolescents

Background and Objectives: Globally around half of new HIV infections occur in the age group 15-24. New reported cases of HIV/AIDS in Lebanon show that a younger age group (20-30) is being affected more than ever before. Lebanon is moving forward in implementing a national sexuality education curriculum in all public schools, as a mechanism for raising awareness and for preventing sexually transmitted infections (STI) including HIV among adolescents. However, little is known about adolescents' actual sexual behavior, the extent to which students are confident of their refusal skills, and the factors that determine these. Young adolescents, who have limited sexual knowledge and experience, may have difficulty in adopting the appropriate protective behavioral responses to prevent negative health outcomes including STI and HIV infection. Methods: This research identified the prevalence and risk factors for perceived sex refusal skills among Lebanese adolescents in grades 7-9 in public and private schools using the nationally representative Lebanon Global School Health Survey. Results: Results indicated that more than 40% (50.4% of boys and 34.8% of girls) of students did not feel confident that they could tell someone they did not want to have sexual intercourse with them. Multivariate logistic regression analysis indicated that being female, older and having close parental supervision predicted having perceived sex refusal skills among Lebanese adolescents. Moreover, having knowledge and/or education about risky behaviors was the strongest predictor for having perceived sex refusal skills among Lebanese adolescents. Conclusion: This study contributes to the limited literature on perceived sex refusal skills in Lebanon, the Middle East and North Africa. A number of recommendations for research and prevention programs can be drawn from this research. Advocacy efforts should target policy makers to ensure that policies are reviewed to support comprehensive sexuality education in Lebanese schools because of identified vulnerabilities of sexual violence, low levels of education or knowledge of risky behaviors including HIV risk, and low levels of perceived sex refusal skills.

Sexual, Behavioral, and Social Characteristics of Female Sex Workers and Their Risk of Sexually Transmitted Infections: In South Korea

This study calculated the sexually transmitted infection (STI) prevalence rates among female sex workers (FSWs) in South Korea and elucidated the social and behavioral risk factors that affect FSW’s infection with STIs. FSWs were recruited using a multistage cluster probability sampling method (N = 1,073). STI prevalence rates were 9.8 % for Treponema pallidum, 2.6 % for gonorrhea, and 12.5 % for Chlamydia. The risk probability of STI infection was higher for participants with fewer social relationships (OR = 0.99), more suicide attempt experiences (OR = 1.36), lower frequency of condom use (OR = 0.81), lower self-efficacy (OR = 0.78), and more irregular STI examination experiences (OR = 0.69). The STI prevalence rates of FSWs in South Korea were lower than those of FSWs in other Southeast Asian nations. While the direct factors for STI prevalence among this population were related to safe sex, indirect factors such as social support were also significant. Because this affects the self-efficacy of isolated individuals among sex workers, preventive interventions in STIs among FSWs must be expanded to the promotion of social support and mental health programs.

Impact of Condom Use and Standardized Sexually Transmitted Disease Treatment on HIV Prevention Among Men Who Have Sex with Men in Hunan Province: Using the Asian Epidemic Model

We evaluated the HIV/AIDS epidemic among men who have sex with men (MSM) in Hunan Province using the Asian Epidemic Model (AEM) and explored the impact of both condom use and standardized STD treatment on HIV prevention programs. The AEM was used to estimate HIV infection under four different scenarios: (1) condom use among MSM maintained at the 2005 level, (2) condom use among MSM improved since 2005, (3) the sexually transmitted infection (STI) prevalence rate among MSM maintained at the 2008 level, and (4) the STI prevalence rate among MSM improved since 2008. Compared with the rate of condom use at the 2005 level among MSM, if the rate of condom use had continuously improved, the number of new infections would have been reduced by 79.1% and the number of people living with HIV and AIDS would decrease by more than 8600 by 2020 and the cumulative number of new infections would have been reduced by 63.6% since 2006 while the number of new HIV infections among females would decline from 2015 with a drop of over 35% by 2020. When compared with the projection based on an unchanged rate of STI infection, the number of new HIV infections would decrease by 49.4% by 2020, and the decreased number of people living with HIV and AIDS would be more than 4000. The total number of 5200 newly infected HIV cases could be reduced from 2006 to 2020 and the number of newly infected HIV cases among the general female population would be reduced by 15.4%. With both the increased rate of condom use and standardized STD treatment for the MSM population in Hunan Province, the spread of HIV infection in both MSM and the general female population would decrease.

Just Another Manic Monday: Peaking Sexual Concerns After the Weekend

The so-called “weekend effect” is a well-known phenomenon in the stock market (Keim & Stambaugh, 1984). This relates to significantly lower stock returns on Monday in comparison with other days of the week. It is suggested that this effect could be a result of traders’ fading optimism between Friday and Monday. Interestingly, similar “weekend effects” can also be found in health-related matters. The number of suicides, for example, is higher on Monday in comparison with other days (McCleary, Chew, Hellsten, & Flynn-Bransford, 1991). In addition, calls to the AIDS-STI telephone hotline, an information helpline that people call mainly when they are concerned about their personal risk on having contracted a sexually transmitted infection (STI) (Mevissen et al., 2011a), also peak on Monday (M. Mientjes, STI AIDS Netherlands, personal communication). How can these peaks in sexual concerns on Mondays be explained? The first explanation that comes to mind is that the frequency of (unprotected) sex is higher on Fridays and Saturdays (Schroder, Johnson, & Wiebe, 2007), resulting in more concerns on what may have gone wrong afterwards (e.g., contracting an STI). Telephone information helplines being closed during the weekend, resulting in an accumulation of concerns, can furthermore explain the high number of calls on Mondays. Nowadays, however, the Internet is used as well to deliver counselling services (e.g., websites aimed at communicating personal risk on contracting an STI) (Mevissen, Ruiter, Meertens, Zimbile, & Schaalma, 2011b). These services are accessible 24/7. Thus, instead of waiting to be able to call on Monday, Internet-delivered counselling services can be used immediately. Hence, one would expect that the use of these services peaks on Saturday and Sunday, after having had unprotected sex on Friday or Saturday night. An advantage of Internet-delivered counselling services is that visitors’ behavior (e.g., use of the service) can be tracked by means of server registrations. In contrast to self-reports, tracking visitors’ behavior is independent of visitors’ memory, interpretation or social desirability (Crutzen & Goritz, 2010) and this provides valuable information about the actual use of Internet-delivered counselling services (Crutzen, Peters, Dias Portugal, Fisser, & Grolleman, 2011). Figure 1 provides an overview of the number of visitors per day during 2 months (April 1–June 1, 2011) for a website of STI AIDS Netherlands (www.soatest.nl) that provides visitors tailored information about the need to conduct an STI test taking into account their sexual behavior. A remarkable finding—given that the website is accessible 24/7—is that the number of visitors per day still peaks each Monday (the only exception being April 25, which is Easter Monday and a Dutch holiday, where the peak is on Tuesday). These figures are comparable to a previous study concerning an emergency contraception website (Wynn & Trussell, 2005) that found peaking e-mails on Monday. The Dutch higher online use rates on Monday cannot be explained by lack of Internet access at home, thus resulting in accessing the website at work, as suggested by Wynn and Trussell (2005), because the Netherlands has one of the highest Internet penetration rates in the world (88.6%, http://www.internetworldstats.com/). Fig. 1 Number of visitors per day (April 1–June 1, 2011; vertical lines indicate Mondays) An explanation for the delay between being concerned about contracting an STI (i.e., “the morning after”) and actually taking action by visiting an Internet-delivered counselling service may be the “deliberation-without-attention effect”: deliberation in the absence of conscious attention directed to the problem (e.g., being concerned about contracting an STI). In the vernacular, this is called “sleeping on it.” Previous research demonstrated that choices in complex matters benefit from leaving them to unconscious thought (as opposed to simple choices, such as choosing one’s favorite between different towels) (Dijksterhuis, Bos, Nordgren, & Van Baaren, 2006). So, although Internet-delivered counselling services are accessible 24/7, this does not mean that people actually visit them immediately when they are concerned. This is not necessarily a bad thing from a decision-making point of view; in the end, the services were used. However, since quickening action is called for in the case of a potential STI infection or an unplanned pregnancy, it is important for future research to focus on reasons behind this phenomenon. Furthermore, from a practical point of view, it is recommendable for offline counselling services (e.g., telephone information helplines) to take this weekend effect into account by increasing their capacity on Mondays.

P1-S2.11 High prevalence of HIV, other sexually transmitted infections and risk profile in male commercial sex workers who have sex with men in the Netherlands

BackgroundLittle is known about the epidemiology and burden of sexually transmitted infections (STI) in male commercial sex workers who have sex with men (MSM-CSWs) in the Netherlands and other Western...

P1-S5.11 High prevalence of STIs and risk behaviours among persons living with HIV in Nicaragua: missed opportunities for prevention

BackgroundThe UNAIDS Report on the Global AIDS Epidemic estimated that in 2009 Nicaragua had 6900 cases of HIV, almost double the 2001 estimate. Among people living with HIV in Nicaragua,...

P5-S6.09 Using syndromic management of STI as an entry point to HIV prevention intervention in a resource poor setting

IssueAlmost all the patients who presents to the hospital with symptoms and/or signs of sexually transmitted infection have been engaged with unprotected sexual intercourse, thus they are predispose to contacting...

Amphetamine-type stimulant use and HIV/STI risk behaviour among young female sex workers in Phnom Penh, Cambodia

BackgroundUse of amphetamine-type substances (ATS) has been linked to increased risk of HIV and other sexually transmitted infections (STI) worldwide. In Cambodia, recent ATS use is independently associated with incident STI infection among young female sex workers (FSWs). MethodsWe conducted 33 in-depth interviews with women (15–29 years old) engaged in sex work to explore ATS use and vulnerability to HIV/STI. ResultsParticipants reported that ATS, primarily methamphetamine in pill and crystalline forms (yama), were cheap, widely available and commonly used. Yama was described as a “power drug” (thnam kamlang) which enabled women to work long hours and serve more customers. Use of ATS by clients was also common, with some providing drugs for women and/or encouraging their use, often resulting in prolonged sexual activity. Requests for unprotected sex were also more common among alternatives intoxicated clients and strategies typically employed to negotiate condom use were less effective. ConclusionATS use was highly functional for young women engaged in sex work, facilitating a sense of power and agency and highlighting the occupational significance and normalization of ATS in this setting. This highly gendered dynamic supports the limited but emerging literature on women's use of ATS, which to date has been heavily focused on men. Results indicate an urgent need to increase awareness of the risks associated with ATS use, to provide women with sustainable alternatives for income generation, to better regulate the conditions of sex work, and to work with FSWs and their clients to develop and promote culturally appropriate harm reduction interventions.

Large loop excision of transformation zone procedures used in the management of cytological abnormalities of the cervix

National Health and Medical Research Council (NHMRC) guidelines published in 2005 changed the management of cervical squamous intraepithelial lesions. Asymptomatic low-grade abnormalities may be treated conservatively as many regress spontaneously. Cervical changes reflect infection with the human papilloma virus (HPV). Risk factors for acquiring HPV are the same as those for other sexually transmitted infections (STIs). To perform a comparison of the Papanicolaou (PAP) smear, histology results of the cervical biopsy and large loop excision of transformation zone (LLETZ) to determine what proportion were over treated, and conversely what proportion would have been under treated in relation to the 2005 NHMRC guidelines. This group of patients was reviewed also for history of STI or concurrent infection. Retrospective chart audit of LLETZ procedures and related histology in a population of women under 25 years between 1999 and 2003 presenting to a colposcopy clinic at a regional hospital. Two hundred and fifty-one asymptomatic women underwent LLETZ procedures. Of them, 27.6% reported a history of STI and 9.2% had a positive test result or history of Chlamydia. Based on the 2005 NHMRC guidelines, which require high-grade squamous intraepithelial lesions (HSIL) on PAP or biopsy, 34% of women had no indication for LLETZ. Of these, 65% were over treated having no HSIL on LLETZ histology and 35% would have been under treated. The 2005 NHMRC guidelines should result in 33.9% fewer LLETZ procedures being performed in the younger age group. This has benefits for their future fertility needs. STI screening would be beneficial in this group when seen at colposcopy clinics, as they have significant rates of prior or current infection.

Reductions in sexually transmitted infections associated with popular opinion leaders in China in a randomised controlled trial

ObjectivesA community level randomised controlled trial of a Community Popular Opinion Leader (C-POL) intervention to reduce bacterial and viral sexually transmitted infections (STIs) and unprotected extramarital sex was carried out...

Reducing sexually-transmitted infection risk in young people with first-episode psychosis

There is emerging evidence that young people with first-episode psychosis are at greater risk of sexually-transmitted infections (STI) than their peers. Theoretical constructs central to behavioural change theories, broadly defined as sexual health-related knowledge, attitudes, and beliefs, have guided most sexual risk-reduction interventions in other at-risk populations. The role of these constructs in the sexual risk behaviour of young people with early psychosis remains unknown. A convenience sample of 67 young people with first-episode psychosis and 48 healthy controls matched on a number of sociodemographic characteristics was recruited. Participants completed a survey assessing their sexual behaviour and sexual health-related knowledge, attitudes, and beliefs. Group differences and the role of these constructs in the condom-use behaviour of these young people were examined. Although some differences emerged, group similarities were prominent. Inconsistent condom use was predicted by clinical status, unemployment, and the absence of peer support for condom use. These results support previous findings that young people with psychosis have greater needs for STI prevention due to increased rates of unprotected sex. Risk-reduction interventions that target peer influence are important. Inquiry into a broader range of psychosocial factors could further our understanding of STI infection risk in early psychosis.

Young Women Engaged in Sex Work in Phnom Penh, Cambodia, Have High Incidence of HIV and Sexually Transmitted Infections, and Amphetamine-Type Stimulant Use: New Challenges to HIV Prevention and Risk

To estimate prevalence and incidence of HIV and sexually transmitted infections (STI) and associated risk factors among young women working as sex workers (SWs) in Phnom Penh, Cambodia. A prospective study of young (<29 years) women working as SWs in brothels, entertainment establishments, and freelance. Sociodemographics, sexual risk, and use of amphetamine-type stimulants (ATS) ("yama" and "crystal") were assessed by self-report. HIV and STI (Chlamydia trachomatis and Neisseria gonorrhoeae) testing were conducted on blood and urine specimens, respectively. Baseline prevalences of HIV, C. trachomatis, and N. gonorrhoeae were 23%, 11.5%, and 7.8%, respectively. HIV incidence was 3.6 per 100 person-years (95% confidence interval [CI], 1.2%-11.1%); STI incidence was 21.2 per 100 person-years (95% CI, 12.6%-35.8%). At baseline, 26.5% reported recent ATS use. HIV infection was associated with freelance SW (adjusted odds ratio, 5.85; 95% CI, 1.59-21.58) and younger age of first sex (≤15 years; adjusted odds ratio, 3.06; 95% CI, 1.01-8.46). Incident STI was associated with duration (per year) of SW (adjusted hazard ratio, 1.1; 95% CI, 1.1-1.2) and recent yama use (adjusted hazard ratio, 3.9; 95% CI, 1.5-10.3). HIV and STI infection rates were high among SWs working in various settings; freelancers had highest risk. ATS use was associated with incident STI. Venue of sex work and drug prevention should be considered in prevention programs.

Sexual and Reproductive Health Behaviors of Undocumented Migrants in Geneva: A Cross Sectional Study

Undocumented migrants face major barriers in accessing prevention and health care. Whereas the association between low socioeconomic status and poor health is well documented only few studies have addressed specific health issues in undocumented migrants. The aim of the present study is to describe sexual and reproductive health behaviors of undocumented migrants in Geneva. This descriptive cross sectional study included consecutive undocumented migrants presenting from November 2007 to February 2008 to a health facility offering free access to health care to this population. Following informed consent, they completed a self administered questionnaire about their socio-demographic profile and sexual and reproductive health behaviors. A total of 384 patients were eligible for the study. 313 (82%) agreed to participate of which 77% (241 patients) completed the survey. Participants were mainly young, Latino-American, single, well-educated and currently working women. They had multiple partners and reported frequently engaging in sexual intercourse. Use of contraceptive methods and strategies of prevention against sexually transmitted infections (STI) were rare. Nearly half of the women had had at least one induced abortion and 40% had had an unplanned pregnancy. One in four participants reported a current or past STI or other genital infection. The results of our study suggest that undocumented migrants engage in frequent and high risk sexual intercourse with insufficient use of contraceptive methods and suboptimal strategies of prevention against STI. Our study underlines the real need for specific sexual and reproductive educational programs targeting this hard to reach population.

Spatial Mobility, Alcohol Use, Sexual Behavior and Sexual Health Among Males in India

This paper examines the linkages of permanent migration, temporary mobility and alcohol consumption with risky sexual behavior and sexually transmitted infections (STIs) including HIV infection among males in India using a nationally representative dataset. The study shows that non-migrant men and migrant men do not differ significantly in any indicator of risky sexual behavior and STIs. Temporary long duration mobile men reported significantly more often than the non-mobile men or short duration mobile men that they had sex with multiple sex partners during their lifetime as well as sex with a high risk partner and had paid sex in the 12 months preceding the survey. Males who drank alcohol almost every day notwithstanding with their migration or mobility status were most prone to lifelong as well as more recent sexual risk behavior. Controlling for sociodemographic characteristics long duration mobile men and men who used alcohol almost daily had higher sexual risk behaviors and STI infections. Further migration and mobility did not show any significant relationship with tested HIV prevalence among males in India, controlling for sociodemographic characteristics. Males who had lifetime multiple sex partners were at the highest risk of tested HIV infection controlling for sociodemographic characteristics, migration, mobility, alcohol use and STI infection. Interventions focusing on HIV prevention in India need to target both non-migrant and migrant men, particularly those who drink alcohol more frequently or daily. Targeted interventions are required for temporary mobile men, particularly for those mobile men who have to stay away from their homes continuously for a longer duration. Long duration mobile men are most prone to regular alcohol use and risky sexual behavior.

Demographic and behavioral characteristics of non-sex worker females attending sexually transmitted disease clinics in Japan: a nationwide case-control study

BackgroundAlthough number of sexually transmitted infections (STIs) reported in STI surveillance increased rapidly for women in Japan during the 1990s, the sexual behavior of women potentially at risk of STI infection remains unknown.MethodsIn order to determine the demographic and behavioral characteristics of non-sex worker (SW) females attending STI clinics, female attendees (n = 145), excluding SW, from nine clinics across Japan and female controls from the general population (n = 956), both aged 18-50 years, were compared using two data sets of nationwide sexual behavior surveys conducted in 1999.ResultsAlthough the occupation-type and education level were unrelated to STI clinic attendance in multivariate analysis, non-SW females attending STI clinics were younger (adjusted odds ratios [AOR] = 0.94, 95%CI: 0.89, 0.99), and more likely to be unmarried (AOR = 4.11, 95% CI: 1.73, 9.77) than the controls from the general population. In the previous year, STI clinic attendees were more likely to have had multiple partnerships (AOR = 3.09, 95% CI: 1.42, 6.71) and unprotected vaginal sex with regular partners (AOR = 3.59, 95% CI: 1.49, 8.64), and tended to have had their first sexual intercourse at a younger age (AOR = 1.77, 95%CI: 0.89, 3.54) and more unprotected vaginal and/or oral sex with casual partners (AOR = 2.08, 95%CI: 0.75, 5.71). Identical sexual behavior patterns were observed between the female attendees with a current diagnosis of STI (n = 72) and those before diagnosis (n = 73) and between those with a past history of STI (n = 66) and those without (n = 79).ConclusionThese results indicate that not only multiple partnerships or unprotected sex with casual partners, but also unprotected vaginal sex within a regular partnership is prevalent among non-SW female STI clinic attendees. The identical sexual behavior patterns observed between female attendees with a current STI diagnosis and those without, and between those attendees with a past history of STI diagnosis and those without, indicate that the result are unlikely confounded with the cases of non-STI infection. This sexual behavior pattern may be predictive of STI infection among young Japanese women and could have contributed to the STI epidemic in women in Japan during the 1990s.

Microbiological diagnosis of sexually transmitted infections (STI): Part 1. Non-viral STI

Non-viral sexually transmitted infections (STI) are an important cause of physical, psychological and social distress, have severe consequences for women's reproductive health and may be transmitted to the newborn child. These infections are also risk factors for the acquisition and transmission of HIV and other STI, and for premature labor. In the last years we have observed a gradual decrease in the national incidence of gonorrhea. The implementation of a screening program in our country for Chlamydia trachomatis is necessary, since up to 80% of infections in women are asymptomatic. Due to medical, psychosocial and legal reasons, laboratory diagnosis of STI has to be certain. This offers a great challenge to laboratories. Since etiological agents are susceptible to environmental conditions, present a high adaptation to their human host and have particular physiological characteristics, their laboratory diagnosis is more difficult than diagnosis of conventional microorganisms. Otherwise, the diagnostic techniques currently available for non-viral STI are characterized by their excellent sensitivity and specificity, which result of great interest given the curable nature of these infections. Clinical specimens obtained for diagnosis of STI and other genital infections, such as bacterial vaginosis or Candidiasis represent a large proportion of specimens processed by clinical laboratories. Thus, the creation of norms and quality control guidelines for laboratories which diagnose these infections, and also the epidemiologic and genetic surveillance of circulating sex transmitted microorganisms should be considered a priority in our country. The objective of this study is to review current literature on accurate diagnostic procedures especially for three non-viral STI agents: C. trachomatis, N. gonorrhoeae, and Trichomonas vaginalis.

Diagnóstico microbiológico de las infecciones de transmisión sexual (ITS): Parte 1. ITS no virales

Non-viral sexually transmitted infections (STI) are an important cause of physical, psychological and social distress, have severe consequences for women's reproductive health and may be transmitted to the newborn child. These infections are also risk factors for the acquisition and transmission of HIV and other STI, and for premature labor. In the last years we have observed a gradual decrease in the national incidence of gonorrhea. The implementation of a screening program in our country for Chlamydia trachomatis is necessary, since up to 80% of infections in women are asymptomatic. Due to medical, psychosocial and legal reasons, laboratory diagnosis of STI has to be certain. This offers a great challenge to laboratories. Since etiological agents are susceptible to environmental conditions, present a high adaptation to their human host and have particular physiological characteristics, their laboratory diagnosis is more difficult than diagnosis of conventional microorganisms. Otherwise, the diagnostic techniques currently available for non-viral STI are characterized by their excellent sensitivity and specificity, which result of great interest given the curable nature of these infections. Clinical specimens obtained for diagnosis of STI and other genital infections, such as bacterial vaginosis or Candidiasis represent a large proportion of specimens processed by clinical laboratories. Thus, the creation of norms and quality control guidelines for laboratories which diagnose these infections, and also the epidemiologic and genetic surveillance of circulating sex transmitted microorganisms should be considered a priority in our country. The objective of this study is to review current literature on accurate diagnostic procedures especially for three non-viral STI agents: C. trachomatis, N. gonorrhoeae, and Trichomonas vaginalis.

The Male Sexual Partners of Adult Versus Teen Women With Sexually Transmitted Infections

We compared the male sexual partners of teen girls of age 15 to 19 years, currently infected with a sexually transmitted infection (STI) versus the male partners of adult women of age 20 to 41 years, with an STI to determine risk factors in these high-risk sexual dyads related to the male partner. Interview of 514 men who were partnered with 152 teen girls and 362 adult women, enrolled in Project Sexual Awareness for Everyone, a randomized controlled trial of behavioral intervention to reduce recurrent STIs. Compared to the male partners of adult women, male partners of teen girls were significantly more likely (P < 0.05) to be infected with any STI at intake. Men partnered with teens were younger and had significantly more sexual partners per year sexually active, shorter relationship length, and shorter length of monogamy with the index girls. They were more likely to report that it was "really important" for the teen to have their baby (P = 0.04) and were slightly more likely to be the father of her children (P = 0.17). Young age independently predicted STI infection in men. Although all women had an STI at intake, important differences were noted among the male partners of teens versus adults. Clinicians with similar populations may use this data to understand the characteristics of male partners of teens with STIs, in order to more effectively counsel adult and teen women on partner notification, treatment and STI prevention.

Alcohol and transactional sex: How risky is the mix?

This study examines alcohol use, transactional sex (TS), and sexually transmitted infection (STI) risk among sugar plantation residents near Moshi, Tanzania, from 2002 to 2004. We compare popular discourse gathered through ethnographic methods with cross-sectional questionnaire and STI prevalence data to illuminate the close correspondence of alcohol use and TS with STI transmission. People attributed to alcohol varied consequences: some socially desirable (relaxing, reducing worries) and others (drunkenness, removing shame) thought to put alcohol abusers at risk for STIs. TS-exchanging money, food, gifts, alcohol or work for sex-was not stigmatized, but people believed that seeking sexual partners for money (or providing money to sexual partners) led to riskier sexual relationships. We explore popular discourse about how alcohol use and TS independently and in combination led to increased STI exposure. Popular discourse blamed structural circumstances-limited economic opportunities, few social activities, separated families-for risky sex and STIs. To understand individual behavior and risk, we surveyed 556 people. We measured associations between their self-reported behaviors and infection with herpes simplex virus type-2 (HSV-2), syphilis, and HIV in 462 participants who were tested. Alcohol abuse was associated with prevalent STI and HIV infection. Exchanging sex for alcohol and work were both associated with prevalent STI. Participants who both abused alcohol and participated in TS had greatest risk for STI. Findings from the two analytic methods-interrogation of popular discourse, and association between self-reported behavior and STIs-were largely in agreement. We posit explanations for discrepancies we found through the concepts of sensationalization, self-exceptionalization, and the influence of an authoritative moral discourse.

The Prevalence of Rectal, Urethral, and PharyngealNeisseria gonorrheaeandChlamydia trachomatisamong Asymptomatic Men Who Have Sex with Men in a Prospective Cohort in Washington, D.C.

The Prevalence of Rectal, Urethral, and Pharyngeal<i>Neisseria gonorrheae</i>and<i>Chlamydia trachomatis</i>among Asymptomatic Men Who Have Sex with Men in a Prospective Cohort in Washington, D.C.