A research report submitted to the Faculty of Health sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Medicine in Epidemiology and Biostatistics 30th May 2012 / Introduction The burden of HIV/AIDS is higher in the sub-Saharan region and multiple sexual partnerships are among the sexual behaviors that put people at risk of HIV transmission. The main aim of this study was to determine the prevalence and associated demographic, socio-economic and behavioral factors of multiple sexual partnerships among men in Zimbabwe. Materials and Methods This was an analytical cross-sectional study that used data from the Zimbabwe Demographic Health Survey 2005-06. Negative binomial regressions were fitted to identify factors associated with multiple sexual partnerships among men in Zimbabwe. Results The prevalence of multiple sexual partnerships was 13.5 %, 12.9%, and 11.2% among the formerly, never and currently married men respectively. Among the formerly married men, the risk factors significantly associated with multiple sexual partnerships included access to newspapers (RR= 1.28; 95% CI:1.02 , 1.60). Formerly married men aged 35-44 years had lower risk of engaging in multiple sex partnerships (RR = 0.59, 95%CI: 0.42, 0.83) than the other age groups. Relative to formerly married men in Manicaland, formerly married men in Mashonaland East region had lower risks of having more sexual partners. Age at first intercourse and sexual attitude were also significantly associated with multiple sexual partnerships among the formerly married men iv Among the never married men, the risk factors associated with multiple sexual partnerships included employment status (RR = 1.33%; 95%CI: 1.17, 1.52), Watching TV (RR = 1.33%; 95%CI: 1.05, 1.69) and sexual attitude (RR = 1.37%; 95% CI: 1.05, 1.79). Relative to never married men in Manicaland, the never married men in Mashonaland East and Mashonaland West had lower risks of having multiple sexual partners. Among the married men, the risk factors associated with multiple sexual partnerships included first intercourse at the age of 19 years or below (RR = 1.07%; 95% CI: 1.04, 1.11) and sexual attitude (RR = 1.16%; 95% CI: 1.09, 1.23). Protective factors included higher level of education (RR = 0.87%; 95% CI: 0.77, 0.98), being 35-44 (RR = 0.94%; 95% CI: 0.89, 0.99) or 45-54 years old (RR = 0.93%; 95% CI: 0.88, 0.99) and being from Mashonaland East (RR= 0.89%; 95%CI: 0.85, 0.93) region. Discussion and Conclusions The results show that after adjusting for potential confounders in the multivariate negative binomial regression analysis; age, geographical region, education, working status, frequency of reading newspapers/magazines/TV, age at first intercourse and sexual attitude remained significantly associated with MSP. However, the extent to which each of these factors was associated with multiple sex partnership varied among marital status groups, therefore HIV/AIDS intervention programs should be designed accordingly.

Multiple sexual partnerships are associated with greater risk of HIV, sexually transmitted infections (STIs) and intimate partner violence. Namibia has an HIV prevalence of 18% and surveys have shown that up to 40% of men in parts of the country have multiple sexual partners; however, no studies have evaluated characteristics associated with this behavior. We evaluated the relationship between education, occupation, and migration and multiple sexual partnerships among people tested for HIV in Lüderitz, Namibia. Data are taken from a cross-sectional study of 570 men and women conducted in a Voluntary Counseling and Testing Center from September-November 2009. Multinomial logistic regressions adjusted for relevant confounders suggest that employment other than manual labor is associated with a three-fold increase in the odds of having 4-6 partners over the lifetime (OR=3.44 95%CI: 1.29-9.15) and a non-significant two-fold increase in the risk of having 7 or more partners over the lifetime (OR=1.93 95%CI: 0.57-6.57). Stratification by gender shows that among women, employment other than manual labor is associated with almost a five-fold increase in the odds of having 4 or more sexual partners over the lifetime (OR=4.58 95%CI: 1.48-14.23). Women with an education of grade 12 or higher also have increased odds of having 4 or more sexual partners over the lifetime (OR=3.78 95%CI: 1.26-11.36). Results show no significant associations with migration, or among men for any exposure variables. Although further studies are warranted, results suggest that programs for HIV and STI intervention and family planning among women should be aimed at workplaces.

<p><font size="4" face="TrebuchetMS,BoldItalic"><font size="4" face="TrebuchetMS,BoldItalic"> <p>The study used a qualitative approach. Fourteen (14) in-depth interviews were conducted with English and Luganda speaking adult male and female clients on antiretroviral treatment (ART), in TASO Mulago. A focus group discussion (FGD) was conducted with 8 purposively selected ART clients who were considered to be &lsquo / expert&rsquo / clients in TASO Mulago. These participants were expert clients/ peer educators, who were open about their HIV status and have been involved in HIV/AIDS education and advocacy. The individual interviews and the focus group discussion were transcribed verbatim, and subjected to thematic and content analysis. Male and female participants who were married (primary relationship) disclosed their sero-status to their sexual partners, while few of those cohabiting or in steady relationship (only one) disclosed to their partners. Enabling factors to disclose to current sexual partners included: desire for partner to get treatment, need for the partner&rsquo / s support, having prior knowledge of partner&rsquo / s HIV status, out of anger, and having anxiety about the future. Some of the barriers to disclosure included: fear of blame and disappointing the partner, fear of abandonment, fear of stigma and discrimination. Participants suggested that couple counselling and testing, economic independence, peer support and involvement of the TASO staff in disclosure should be considered to facilitate or promote disclosure to sexual partners.</p> </font></font></p>

<p><font size="4" face="TrebuchetMS,BoldItalic"><font size="4" face="TrebuchetMS,BoldItalic"> <p>The study used a qualitative approach. Fourteen (14) in-depth interviews were conducted with English and Luganda speaking adult male and female clients on antiretroviral treatment (ART), in TASO Mulago. A focus group discussion (FGD) was conducted with 8 purposively selected ART clients who were considered to be &lsquo / expert&rsquo / clients in TASO Mulago. These participants were expert clients/ peer educators, who were open about their HIV status and have been involved in HIV/AIDS education and advocacy. The individual interviews and the focus group discussion were transcribed verbatim, and subjected to thematic and content analysis. Male and female participants who were married (primary relationship) disclosed their sero-status to their sexual partners, while few of those cohabiting or in steady relationship (only one) disclosed to their partners. Enabling factors to disclose to current sexual partners included: desire for partner to get treatment, need for the partner&rsquo / s support, having prior knowledge of partner&rsquo / s HIV status, out of anger, and having anxiety about the future. Some of the barriers to disclosure included: fear of blame and disappointing the partner, fear of abandonment, fear of stigma and discrimination. Participants suggested that couple counselling and testing, economic independence, peer support and involvement of the TASO staff in disclosure should be considered to facilitate or promote disclosure to sexual partners.</p> </font></font></p>

Magister Public Health - MPH / The increased number of new infections in Uganda necessitates HIV prevention programmes that address risky behaviours especially among heterosexual populations. The AIDS Support Organisation (TASO) is the largest indigenous HIV/AIDS agency serving Uganda and the Great Lakes Region. TASO endeavours to empower sexually active clients to disclose their sero-status to their sexual partners and promotes partner testing for HIV. In spite of these efforts, only 12% of 2,071 sexually active clients in Mulago centre had disclosed by the end of 2006. This study aimed to explore the factors that influence clients’ decisions to disclose their HIV status to their partners in TASO Mulago, Kampala, Uganda. The study used a qualitative approach. Fourteen (14) in-depth interviews were conducted with English and Luganda speaking adult male and female clients on antiretroviral treatment (ART), in TASO Mulago. A focus group discussion (FGD) was conducted with 8 purposively selected ART clients who were considered to be ‘expert’ clients in TASO Mulago. These participants were expert clients/ peer educators, who were open about their HIV status and have been involved in HIV/AIDS education and advocacy. The individual interviews and the focus group discussion were transcribed verbatim, and subjected to thematic and content analysis. Male and female participants who were married (primary relationship) disclosed their sero-status to their sexual partners, while few of those cohabiting or in steady relationship (only one) disclosed to their partners. Enabling factors to disclose to current sexual partners included: desire for partner to get treatment, need for the partner’s support, having prior knowledge of partner’s HIV status, out of anger, and having anxiety about the future. Some of the barriers to disclosure included: fear of blame and disappointing the partner, fear of abandonment, fear of stigma and discrimination Participants suggested that couple counselling and testing, economic independence, peer support and involvement of the TASO staff in disclosure should be considered to facilitate or promote disclosure to sexual partners.While strategies like HBHCT and couple counselling have enhanced disclosure among sexual partners on ART living together in stable married relationships (primary), the partners in secondary relationships (cohabiting and steady) especially women, continue to face challenges in disclosure yet their sexual partners are at risk of HIV infection. The study has re-affirmed the fact that while some people living with HIV/AIDS wish to disclose their HIV status to their partners, there are compound factors that make it difficult to disclose. This calls for effective strategies by government, TASO and other agencies to ensure that sexual partners especially in cohabiting and steady relationships are disclosed to in order to reduce their vulnerability to HIV infection.

Using the perspective of sexual script theory (Gagnon & Simon, 1973) and growth curve modeling, this study examined whether characteristics of parents and parent-adolescent connectedness influence change in lifetime number of sexual partners from adolescence through young adulthood. Living in a blended family, having at least one college-educated parent and on-time parent-adolescent sexual communication positively predicted later lifetime number of sexual partners. Parent religiosity and parent-adolescent connectedness negatively predicted later lifetime number of sexual partners. Parent-adolescent sexual communication that focused on negative consequences of sex and parent disapproval of adolescent sexual activity were not significant in the overall model. Control variables included adolescent race/ethnicity, gender, physical maturity, marriage history, virginity pledge history, and expectations of positive consequences of sex. Physical maturity and gender were not significant in the overall model. In conclusion, parents have significant and far-reaching influence on their children's later sexual behavior. This study extended research in the field by examining lifetime number of sexual partners across four time points, which allowed observation of change in this outcome variable with age and accounted for the nested nature of the data. / Master of Science

Sexual health is an important component to overall well-being and quality of life. Yet so much of sexual health research is focused solely on the negative consequences of sexuality, such as unintended pregnancy and transmission of sexually transmitted infections. Recently, the need for a positive, health promotion focused framework for research and understanding sexual health has received attention, including from the World Health Organization and the Centers for Disease Control and Prevention. This transition of public health research and practice from a disease-based framework to a positive, health promotion framework necessitates exploring what factors are associated with positive sexuality and how it is experienced. This study contributed to fulfilling this need. This study focused on healthy sexuality in young college women. Specifically, this study sought to explore what young women find sexually satisfying in different types of sexual relationships (e.g., casual and committed partners). Next, this study identified variables that are important to the healthy sexuality of young college women, including sexual self-concept, communication with sexual partners, sexual satisfaction, and condom use. Lastly, this study aimed to understand the statistical relationship between these variables. This was a two-phase mixed methods study. Phase one consisted of thirty face to face individual interviews with college women aged 18-25 years, and took place in the fall semester of 2011 and the spring semester 2012 at a large public urban university located in the southeastern United States. Phase two took place in the spring semester 2012 and consisted of an online quantitative survey measuring sexual self-concept, communication with partners, sexual satisfaction and condom use. Analyses for the quantitative data included bivariate correlations and structural equation modeling. Qualitative results indicated that these young college women experienced sexual satisfaction with both committed and casual sexual partners, although they identified different reasons why each type of partnership was satisfying. Specifically, the emotional connection and comfort felt with committed relationship partners made sex satisfaction. With more casual or uncommitted partners, these women identified the benefits of maintaining their freedom and not having an obligation to another person. These young women shared their thoughts on how sex could be more satisfying for women and they indicated that communicating sexual desires and needs to partners as one of the most important factors. The quantitative portion of this study found that sexual self-concept was directly positively associated with communication with sexual partners (B=1.45, 95% CI=1.05 1.84, beta=.72), and directly positively related to sexual satisfaction (B=.49, 95% CI= .70, 2.35, beta=.49). Communication with partners was associated with lower discrepancies between wanted and experienced sexual activities (B=-3.96, 95% CI=-4.96, -2.95, beta=-.41). For respondents reporting on committed partnerships, communication with partners was directly related to higher sexual satisfaction (B=.74, 95% CI=.17, 1.32, beta=.43). For those reporting on casual sexual partners, communication was related to sexual satisfaction only through lower sexual activity discrepancy scores (B=.07, 95% CI=.01, .13, beta=.04). Overall the findings from this study suggest that communicating with casual sexual partners impacts sexual satisfaction partially through decreasing the discrepancies between wanted and experienced sexual activities. However, for committed partners, discrepancies were not significantly related to sexual satisfaction, directly or indirectly, although communication was directly associated with sexual satisfaction. This suggests that communication is impacting sexual satisfaction through a different mechanism for committed partners than casual partners. The significance of this study lies in its contribution to the positive sexuality literature, which is currently still in its infancy. This study has implications for public health practice in the improvement of health promotion/sex education programs. This study identified sexual self-concept and communication between partners as important factors for achieving authentic sexual experiences. The implications of this study for public health research include the identification of variables important to understanding women's experience of positive sexuality. Specifically, this study found sexual self-concept to be important to communication and sexual satisfaction, and identified communication as important for both risk reduction (e.g., condom use) and sexual health promotion (e.g., sexual satisfaction).

Introduction: Human papillomavirus (HPV) is the most commonly occurring sexually transmitted infection and is a necessary cause of cervical cancer. The progression from HPV infection to cervical cancer is incompletely understood. Innate immune response to HPV infection has recently been identified as a potential cofactor in this progression. This study examined potential association(s) between killer cell immunoglobulin-like receptors (KIR) and HPV infection. HPV concordance was estimated among heterosexual couples demonstrating the complexity of HPV infection.Methods: HPV concordance was cross-sectionally estimated in 29 heterosexual couples. A polymerase chain reaction based assay for KIR genotyping was developed and validated. 283 women from the Young Women's Health Study and 259 men from the HPV Infection in Men: A Prospective Cohort Study had HPV infection data and samples available for KIR genotyping. Associations between KIR genotype and haplotype with HPV prevalence, incidence and clearance were assessed.Results: Among 29 couples, prevalence for any HPV type was comparable between women 86.2% and men, 75.9%. Partial concordance was observed in 66% of the couples. Forty-one percent (41%) of couples had perfect concordance. A high degree of concordance was observed, however HPV type distributions differed in men and women. In women from the YWHS, KIR2DS5 was significantly associated with oncogenic HPV prevalence (Odds ratio [OR]: 0.56, 95% Confidence Interval [CI]: 0.31-0.99). Any HPV incidence was significantly associated with KIR2DL2 (Hazards Ratio [HR]: 2.11, 95% CI: 1.0-4.44), KIR2DS2 (HR: 2.44, 95% CI: 1.13-5.24), KIR2DS3 (HR: 2.36, 95% CI: 1.16-4.81), and KIR haplotype B (HR: 2.48, 95% CI: 1.02-6.02). Women lacking KIR2DS5 had an increased risk of any HPV acquisition in the presence of KIR2DL2 (HR: 2.95, 95% CI: 1.28-6.86), KIR2DS2 (HR: 3.33, 1.39-7.99), or KIR2DS3 (2.77, 95% CI: 1.24-6.19). In Men, KIR2DS3 was significantly associated with increased probability of any HPV clearance (HR: 1.91, 95% CI: 1.04-3.49).Conclusions: This research contributes to our understanding of HPV infection dynamics through the assessment HPV type concordance in sexual partners. Additionally, through the development of an assay for KIR genotyping, we were able to identify associations with KIR gene positivity and HPV prevalence, incidence, and clearance in men and women.

Introduction HIV remains a severe global health problem. The Republic of Chad is moderately affected (1.3%), compared to Cameroon who suffers more of the burden of the HIV/AIDS (4.5%). We described the HIV risk factors in two neighboring Central African Republics, and compared the gaps in both countries. Methods This was a retrospective cross-sectional study; data was obtained from the Demographic and Health Survey. A stratified multi-stage cluster sample design was conducted. The sample size was 5248 in Chad and 7191 in Cameroon. We used SAS to fit a multilevel logistic model, and conducted a multivariate analysis. Results The median age of respondents was 30 (IQR, 20-40) years in Chad, and 28 (IQR, 20-40) in Cameroon. Only 12.45% reported had ever been tested for HIV in Chad, (41.77% in Cameroon). In Chad, 46.40% of participants did not know a place to get HIV test, (11.15% in Cameroon). The median number of lifetime sexual partners was 2 (IQR, 1-4) in Chad, and 6 (IQR, 3-15) in Cameroon. Among Chadian participants 31.63% had only one lifetime sexual partner, (10.76% in Cameroon). In Chad 86.95% of participants reported having no sex partner other than their spouse in the last 12 months; (57.3% in Cameroon). Conclusion Condom use and HIV testing rates were very low among Chadian men comparing to Cameroonian men; however, Cameroonian men were more likely to engage in multiple sexual partners and extra-marital relationship than Chadian men.

mormaeche@dge.gob.pe / Objective: To assess the seroprevalence of hepatitis B virus (HBV), syphilis, and HIV and associated risk factors in pregnant women and their male partners from six indigenous populations of the Peruvian Amazon Basin. Methods: A cross-sectional study was performed in six indigenous populations from the Peruvian Amazon Basin. Blood samples were obtained and tested for HBV (antibodies to the hepatitis B core antigen (anti-HBc) and hepatitis B surface antigen (HBsAg)), for syphilis (rapid plasma reagin and microhemagglutination assay for Treponema pallidum antibodies), and for HIV (ELISA and indirect immunofluorescence test). A survey was also performed to identify associated risk factors. Results: One thousand two hundred and fifty-one pregnant women and 778 male partners were enrolled in the study. The seroprevalence of anti-HBc in pregnant women was 42.06% (95% confidence interval (CI) 39.28–44.85%) and in their male partners was 54.09% (95% CI 50.32–57.86%). The seroprevalence of HBsAg in pregnant women was 2.11% (95% CI 0.78–3.44%) and in their male partners was 3.98% (95% CI 1.87–6.08%). The seroprevalence of syphilis in pregnant women was 1.60% (95% CI 0.86–2.33%) and in their male partners was 2.44% (95% CI 1.22–3.66%). HIV seroprevalence in pregnant women was 0.16% (95% CI 0.02–0.58%) and in their male partners was 0.29% (95% CI 0.04–1.03%). Sexual risk factors were strongly related to blood markers of syphilis and HBV. Conclusions: Hepatitis B was found to be hyperendemic and strongly related to sexual factors, suggesting an important sexual component in the transmission of the disease in the populations studied. Syphilis was found to have an endemicity in pregnant women above the national level and this may be indicative of high mother-to-child transmission. HIV has started to show its presence in indigenous populations of the Amazon Basin and the results suggest the epidemic is concentrated. / Revisión por pares