Harsh Reality is a print resource aimed toward the population of street-involved youth. Created by a working group of street-involved youth in partnership with a research nurse, Harsh Reality is a unique hybrid of factual information, and art and written experienced submitted by street-involved youth themselves. Harsh Reality contains information about a variety of topics, notably sexually transmitted infections and HIV/AIDS. A case study method was used to evaluate aspects of both project process and outcomes. The case study was guided by three areas of study: street-involved youth's perceptions of the resource, retention of specific knowledge outcomes from the resource, and method of resource distribution. The primary sources of data were street-involved youth themselves. Findings of this study include a description of the target audience's perception of the resource, an analysis of specific knowledge uptake, an assessment of various methods of resource distribution, and possible suggestions for future resources.

Harsh Reality is a print resource aimed toward the population of street-involved youth. Created by a working group of street-involved youth in partnership with a research nurse, Harsh Reality is a unique hybrid of factual information, and art and written experienced submitted by street-involved youth themselves. Harsh Reality contains information about a variety of topics, notably sexually transmitted infections and HIV/AIDS. A case study method was used to evaluate aspects of both project process and outcomes. The case study was guided by three areas of study: street-involved youth's perceptions of the resource, retention of specific knowledge outcomes from the resource, and method of resource distribution. The primary sources of data were street-involved youth themselves. Findings of this study include a description of the target audience's perception of the resource, an analysis of specific knowledge uptake, an assessment of various methods of resource distribution, and possible suggestions for future resources.

The purpose of this study was to describe the sexual health knowledge and attitudes of a sample of Saskatchewan post secondary freshmen aged 17-19. Three primary questions guided this research: What do Saskatchewan freshmen know about the general sexual health topics of physiology, contraception, and sexually transmitted infections? What are common attitudes about sexual activity, risk behaviors, and relationships? What were the main sources of sexual health information for these freshmen, and do they express a need for more education and resources? The study design was a qualitative web-based survey. Participants were volunteer freshmen aged 17-19 from the University of Saskatchewan and Saskatoon Institute of Applied Science and Technology, and 515 responded. Sixty-two percent were sexually active. Condoms were seen as helpful (98%) but only 57% saw them as effective for preventing pregnancy. Only 47% saw condoms as effective for preventing HIV/AIDS. Knowledge of reproductive physiology and STI symptoms and consequences were low with an average knowledge score of 26%, while HIV and AIDS knowledge scores averaged 80%. Knowledge of long acting contraceptives was much lower than birth control pills. Human papilloma virus was poorly understood, and many wanted more information about HPV vaccination. Attitudes were mixed about safe sexual activities, with respondents identifying condoms (94%), withdrawal (18%) and anal sex (15%) as safer sex. Condoms were used at last intercourse by 57%. A variety of attitudes were expressed about condom use, sex in relationship, and social pressures. Topics concerning to respondents were sexual violence, HIV/AIDs, STIs, unintended pregnancy, and the influence of alcohol/ drugs on sexual activity. Very few respondents had heard of or accessed sexual health websites designed and promoted to teens. An interest was expressed for more information from doctors and public health nurses, more guest speakers for SBSHE, and easier access to sexual health clinics. The information gathered in this study highlighted many areas for further detailed inquiry, and topics that can be better addressed in physician’s offices and sexual health curriculum. Additionally, the results could guide sexual health educators, policy makers and direct physicians towards collaboration and advocacy projects, and ultimately contribute to long term improvement in sexual health of Saskatchewan teens.

This thesis presents data on two separate areas relevant to the prevention of HIV and sexually transmitted infection (STI) transmission in homosexual men. These data arise from the community-based Health in Men (HIM) cohort of HIV-negative homosexual men in Sydney. First, the association of circumcision status with HIV and STIs was examined. Older age, ethnicity and country of birth were demographic factors independently associated with circumcision status. Self-report was a valid measure of circumcision status in this population. Overall, being circumcised was associated with a non-significant reduced risk of HIV seroconversion in the HIM cohort (HR 0.76, 95% CI 0.41-1.41, p=0.381). Among the one-third of participants predominantly practising the insertive role in anal intercourse (AI), being circumcised was associated with a significantly reduced risk of HIV infection (HR 0.15, 95% CI 0.03-0.80, p=0.026). Circumcised HIM participants also had a lower risk of incident syphilis (HR 0.35, 95% CI 0.15-0.84, p=0.019), however circumcision status had no significant effect on the remainder of prevalent and incident STIs examined. Second, risk factors for pharyngeal gonorrhoea and chlamydia were investigated. The BD ProbeTec nucleic acid amplification test (NAAT) had a positive predictive value (PPV) for pharyngeal gonorrhoea diagnosis of only 30.4% (95% CI 25.2-36.1%) when compared to a previously validated NAAT targeting the gonococcal porA pseudogene. Pharyngeal gonorrhoea was common in HIM, mostly occurred without concurrent anogenital infection and may frequently spontaneously resolve. Infection was independently associated with younger age (p-trend=0.001), higher number of male partners (p-trend=0.002), contact with gonorrhoea (p<0.001) and insertive oro-anal sex with casual partners (p-trend=0.044). Pharyngeal chlamydia was less common but a high prevalence/incidence ratio suggested that infection may persist in the pharynx for long periods. Pharyngeal chlamydia was independently associated with receptive penile-oral sex with casual partners (p-trend=0.009). In conclusion, circumcision may have a role as an HIV prevention intervention among the subgroup of homosexual men who predominantly practise insertive rather than receptive AI. Regular screening of the pharynx including a validated supplemental NAAT for gonorrhoea diagnosis may prevent much transmission to anogenital sites, whereas chlamydia occurs too infrequently in the pharynx to recommend routine screening in homosexual men.

Good sexual and reproductive health is fundamental to the overall health status of Māori communities. In 2001, the Ministry of Health reported that New Zealand was facing a Chlamydia epidemic. This epidemic has not abated as rates of Chlamydia have increased significantly in the past five years, with disproportionately high rates in young Māori women compared to non-Māori women. Despite significant sexual health disparities, young Māori have had limited opportunities to participate in research focussed on sexual health and voice their opinions and concerns on sexual health issues. This qualitative descriptive study has used a Māori inquiry paradigm and approached the research from a Kaupapa Māori perspective. The primary research question asked what the knowledge, attitudes and reported behaviours of young urban Māori women were in regards to sexual health and in particular, the sexually transmitted infection Chlamydia. Secondary aims were to ascertain the sources of information used and accessibility of sexual health services, as well as identifying resilience factors associated with protection against Chlamydia infection. The data was collected from semi-structured interviews with 16 young Māori women living in the Auckland region. Data analysis involved the inductive approach of categorical content analysis to identify major categorical themes to answer the specific questions posed. The main conclusion was that there are a number of barriers to accessing quality sexual health information and services for young Māori women. Participants’ level of knowledge varied reflecting their personal experiences and many were unaware that Chlamydia is asymptomatic and that delayed diagnosis can lead to fertility problems. The main sources of sexual health information accessed were whānau, peers, school, and contact with health professionals. Racism was identified as one of the barriers to sexual healthcare services. The young women expressed a clear preference for sexual health services to be delivered by Māori. Most importantly, for sexual health interventions to be successful it is essential that Māori communities, including young people and their whānau, are an integral part of creating positive solutions. Resilience factors that may help protect young women from contracting chlamydia characteristic of this group were having a strong connection with a caring adult or friend and parents who viewed sexuality as a normal part of adolescent development. In addition, having a positive Māori cultural identity with an ability to understand bicultural differences was strongly associated with participants accessing sexual healthcare services despite identified barriers.

Orientador: Marli Teresinha Cassamassimo Duarte / Resumo: Introdução: Vulnerabilidade é a possibilidade de a pessoa se expor ao adoecimento, considerando-se fatores individuais e coletivos, dividindo-se em três dimensões analíticas articuladas: a individual, a social e a programática. Em mulheres que fazem sexo com mulheres (MSM) a vulnerabilidade às infecções sexualmente transmissíveis (IST) perpassa por questões de luta por visibilidade social e política, diferença de gênero, padrão heteronormativo, despreparo profissional e o próprio desconhecimento sobre questões relativas à prevenção das IST/aids, ainda pouco estudadas no cenário nacional. Objetivo: Analisar a vulnerabilidade de mulheres que fazem sexo com mulheres às IST/aids. Método: Estudo transversal que integra estudo mais amplo sobre acesso a serviços de saúde e saúde sexual e reprodutiva de MSM. A amostra de 150 MSM residentes no interior Paulista foi constituída por meio da técnica de amostragem Bola de Neve, indicação de profissionais de saúde e liderança LGBT (Lésbicas, Gays, Bissexuais, Travestis e Transexuais) e por procura espontânea, a partir da divulgação do projeto nas redes de sociabilidade, comunicação de massa, serviços de saúde e grupos de ativismo. As variáveis estudadas foram classificadas mediante o referencial teórico da vulnerabilidade. Os dados foram obtidos de janeiro de 2015 a março de 2017, por meio da aplicação de questionário, exame ginecológico e coleta de sangue periférico. Para o diagnóstico das infecções pelo papiloma vírus humano, Chlamydia t... (Resumo completo, clicar acesso eletrônico abaixo) / Doutor

Philosophiae Doctor - PhD / The sexual behaviour of youths is believed to play a role in the spread of SexuallyTransmitted Infections (STIs) and Reproductive Tract Infections (RTIs). This study examinesthe determinants of youth sexual behaviours and knowledge of reproductive tract infections (RTIs) and sexually transmitted infections (STIs) in Malawi. It explores rural/urbandifferentials in sexual behaviours using indicators such as early sexual initiation, multiplesexual partnerships, and non-use of condoms, in order to establish policy recommendationstoward improving sexual behaviour among youths. The Malawi Demographic Health Survey2010 data was used. Out of a sample of 2987 males and 9559 females aged 15-24 years,5652 females and 1405 males (condom use), 675 females and 511 males (inconsistentcondom use), 6470 females and 2026 males (multiple sexual partnerships (MSP)), and 15217females and 1405 males (early sexual debut) were filtered in the study.Chi-square and logistic regression techniques were performed to test for association betweensexual behaviour indicators and socio-demographic variables. The prevalence of non-use ofcondom was higher among catholic females (OR=1.11), lower among Muslim males (OR=0.81) and higher among CCAP females (OR=1.19). Muslim females were (OR=1.42) more likely to initiate sexual activities early, while Muslim males were (OR= 0.57) less likelyto initiate sexually activities early. Females in the central region (OR=1.51) and catholicmales (OR=1.63) were more likely to have more sexual partners.Encouraging these young people to be faithful to one uninfected partner, abstinence fromsexual activities, use condoms consistently and delay sexual initiation will help curb the spread of STIs in Malawi.

Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2012-11-19T18:02:20Z No. of bitstreams: 1 Ana Gabriela Travassos. Prevalencia de infecções...pdf: 1770536 bytes, checksum: 441f7de704dcce48197a2de3df993352 (MD5) / Made available in DSpace on 2012-11-19T18:02:20Z (GMT). No. of bitstreams: 1 Ana Gabriela Travassos. Prevalencia de infecções...pdf: 1770536 bytes, checksum: 441f7de704dcce48197a2de3df993352 (MD5) Previous issue date: 2012 / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, Bahia, Brasil / Avaliar a prevalência de infecções sexualmente transmissíveis (IST) em gestantes infectadas pelo HIV e estimar os fatores de riscos associados acompanhadas no ambulatório de pré-natal no Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), em Salvador, Bahia. Metodologia: Este é um estudo transversal, realizado no período de 01 de outubro de 2010 a 30 de setembro de 2011.Foram convidadas a participar as gestantes que procuraram atendimento no ambulatório de pré-natal do CEDAP. Foram excluídas as pacientes que utilizaram antibióticos há menos de 30 dias, apresentaram complicações obstétricas na primeira consulta como ameaça de abortamento, de parto prematuro e ruptura prematura de membranas. As participantes foram entrevistadas em relação à história sócio-epidemiológica e clínica e testadas para HBsAg,anti HCV,anti HTLV I/II,VDRL,captura híbrida para Chlamydia trachomatis,cultura para Neisseria gonorrhoeae,Mycoplasma hominis e Ureaplasma urealyticum,citologia oncótica para pesquisa de HPV.Obtidas contagens de Linfócitos TCD4 + e carga viral do HIV em amostra sanguínea. Nossa principal variável de desfecho foi a presença de qualquer IST. Resultados: Eram elegíveis 76 gestantes, destas 63 (82,9%) participaram do estudo. A média de idade das pacientes foi de 28,2 anos (16 - 40 anos), e de 19 semanas de idade gestacional ao chegar ao serviço.Foi feito o diagnóstico de pelo menos uma das IST estudadas além do HIV em 23/63 (36,5%) das pacientes.A freqüência dos diagnósticos foi HPV (15,0%), Chlamydia trachomatis (11,1%), sífilis (9,5%), hepatite C (8,1%), HTLV I/II(3,4%), hepatite B (3,2%), Mycoplasma hominis (2,1%) e Ureaplasma urealyticum (2,1%).Não houve diagnóstico de Neisseria gonorrhoeae.Não foi encontrada associação entre as variáveis sócio-epidemiológicas e a presença de IST nas gestantes estudadas.A contagem de linfócitos T CD4<500 cels/mm3 (p= 0,047) e carga viral>1000 cópias (p=0,027) foram associadas à presença de IST.Discussão: A presença de IST em gestantes infectadas pelo HIV é freqüente. Devido a não existência de associação com variáveis sócio-epidemiológicas recomenda-se que todas as gestantes infectadas pelo HIV devem ser investigadas. A associação com baixa imunidade e carga viral aumentada sugere dificuldade de acesso ao acompanhamento adequado. É necessária triagem precoce de IST no cuidado da gestante infectada pelo HIV para evitar um maior prejuízo do sistema imunológico e diminuir a transmissão vertical destas infecções / To evaluate the prevalence of sexually transmitted infections (STI) in HIV infected pregnant women and to estimate the risk factors associated in HIV infected pregnant women followed at the prenatal care in the State Center Specializing in Diagnosis, Care and Research (CEDAP), in Salvador, Bahia. Methodology: This is a cross-sectional study conducted from 1 October 2010 to 30 September 2011. The women who sought prenatal care at CEDAP were invited to participate in the study. We excluded patients who used antibiotics for less than 30 days, had obstetric complications in the first visit such threatened abortion, premature labor and premature rupture of membranes. Participants were interviewed regarding socio-epidemiological and clinical history and tested for HBsAg, anti HCV, anti HTLV I/II, VDRL, Chlamydia trachomatis Hybrid capture, Neisseria gonorrhoeae, Mycoplasma hominis and Ureaplasma urealyticum culture, Pap smear to detect HPV. CD4+ lymphocytes counts and HIV viral load obtained in blood sample. Our main outcome variable was the presence of any STI. Results: Of 76 eligible women, 63 (82.9%) participated. The mean age of patients was 28.2 years (16-40 years), and gestational age on arrival in the service was 19 weeks. The diagnosis of at least one of sexually transmitted infections other than HIV studied in 23/63 (36.5%) patients. The frequency of diagnoses was HPV (15.0%), Chlamydia trachomatis (11.1%), syphilis (9.5%), hepatitis C (8.1%), HTLV I / II (3.4%), hepatitis B (3.2%), Mycoplasma hominis (2.1%) and Ureaplasma urealyticum (2.1%). There was no diagnosis of Neisseria gonorrhoeae. No association was found between socio-demographic variables and the presence of STIs in pregnant women studied. The CD4 T lymphocyte count below 500 cells/mm3 (p = 0.047) and viral load> 1000 copies (p = 0.027) was associated with the presence of STI. Discussion: STI are frequent in pregnant women infected with HIV. Therefore, the lack of socio-epidemiologic association recommends that all HIV pregnant women should be investigated. The association with low immunity and viral load suggests increased difficulty of access to appropriate monitoring. Thus, it is necessary in early screening for STI care of pregnant women infected with HIV to prevent further damage to the immune system and to decrease the transmission of these infections.

Submitted by Juliane Andrade null (juenf_andrade@yahoo.com.br) on 2017-10-03T16:36:04Z No. of bitstreams: 1 julianeandrade.tese.pdf: 1611303 bytes, checksum: 04c4ad64a2c810065ae1a4358aa0ea67 (MD5) / Approved for entry into archive by Monique Sasaki (sayumi_sasaki@hotmail.com) on 2017-10-03T17:00:21Z (GMT) No. of bitstreams: 1 andrade_j_dr_bot.pdf: 1611303 bytes, checksum: 04c4ad64a2c810065ae1a4358aa0ea67 (MD5) / Made available in DSpace on 2017-10-03T17:00:21Z (GMT). No. of bitstreams: 1 andrade_j_dr_bot.pdf: 1611303 bytes, checksum: 04c4ad64a2c810065ae1a4358aa0ea67 (MD5) Previous issue date: 2017-09-06 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Introdução: Vulnerabilidade é a possibilidade de a pessoa se expor ao adoecimento, considerando-se fatores individuais e coletivos, dividindo-se em três dimensões analíticas articuladas: a individual, a social e a programática. Em mulheres que fazem sexo com mulheres (MSM) a vulnerabilidade às infecções sexualmente transmissíveis (IST) perpassa por questões de luta por visibilidade social e política, diferença de gênero, padrão heteronormativo, despreparo profissional e o próprio desconhecimento sobre questões relativas à prevenção das IST/aids, ainda pouco estudadas no cenário nacional. Objetivo: Analisar a vulnerabilidade de mulheres que fazem sexo com mulheres às IST/aids. Método: Estudo transversal que integra estudo mais amplo sobre acesso a serviços de saúde e saúde sexual e reprodutiva de MSM. A amostra de 150 MSM residentes no interior Paulista foi constituída por meio da técnica de amostragem Bola de Neve, indicação de profissionais de saúde e liderança LGBT (Lésbicas, Gays, Bissexuais, Travestis e Transexuais) e por procura espontânea, a partir da divulgação do projeto nas redes de sociabilidade, comunicação de massa, serviços de saúde e grupos de ativismo. As variáveis estudadas foram classificadas mediante o referencial teórico da vulnerabilidade. Os dados foram obtidos de janeiro de 2015 a março de 2017, por meio da aplicação de questionário, exame ginecológico e coleta de sangue periférico. Para o diagnóstico das infecções pelo papiloma vírus humano, Chlamydia trachomatis e Neisseria gonorrhoeae empregou-se a reação em cadeia da polimerase, para confirmação do HIV (Vírus da Imunodeficiência Humana), os testes ELISA e Western Blot, para Hepatite B o ensaio ARCHITECT HBsAg. Para sífilis foi considerado resultado reagente a mulher que teve teste treponêmico e VDRL reagente ou os dois treponêmicos positivos, sem história de tratamento prévio adequado. A identificação do Trichomonas vaginalis se deu a partir da coloração de Papanicolaou. Para análise dos dados foi empregada a estatística descritiva e as associações foram verificadas por regressão logística múltipla e as comparações do escore de vulnerabilidade entre mulheres com e sem histórico de relação sexual com homens foram feitas por meio do teste de Mann-Whitney. Resultados: A mediana de idade das MSM investigadas foi de 26 anos (18-62), 74,7% eram brancas, 73,3% não unidas, 51,3% tinham 12 ou mais anos de estudo concluídos, 74% estavam inseridas no mercado de trabalho e 50,7% tinham renda per capta familiar maior que R$ 1.019,00. A maioria tinha história de relacionamento sexual com homens durante a vida (74,7%), entretanto, nos últimos doze meses, apenas 21,3% se relacionaram com homens. O diagnóstico de alguma IST foi constatado em 47,3% das mulheres. A análise de regressão logística multivariada apontou apenas variáveis da dimensão individual independentemente associadas às IST/aids: não ter realizado sorologia para IST/aids [OR=2,80 (1,13 – 6,94); p=0,027], ter histórico de IST [OR=4,00 (1,03–15,50); p=0,045] e ter tido relação sexual com homem nos últimos 12 meses [OR=8,65 (2,39–31,38); p=0,001]. Segundo a estratégia de análise do grau de vulnerabilidade adotada, nenhuma mulher investigada estava isenta, sendo que a vulnerabilidade programática foi a que apresentou maior mediana do escore de vulnerabilidade, 9,6 pontos (0-24) e a social, a menor, 7,5 pontos (0-19). As mulheres com ou sem histórico de relação sexual com homens na vida não diferiram quanto ao escore de vulnerabilidade na dimensão social e programática e aquelas que se relacionaram com homens na vida apresentaram maior escore na dimensão individual [10,0 (4,0–17,0 vs. 8,0 (4,0–13,0); p= 0,001]. As MSM que tiveram relação com homem nos últimos 12 meses tiveram maior escore de vulnerabilidade individual e social em comparação com aquelas sem este histórico [12,0 (6,0–17,0) vs. 9,0 (4,0–15,0); p=0,000 e 10,0 (0,0–19,0) vs. 5,0 (0,0–14,0); p=0,042, respectivamente] e não apresentaram diferença quanto ao escore de vulnerabilidade programática. Conclusão: As MSM investigadas apresentavam elevada vulnerabilidade às IST/aids nas três dimensões, confirmada pela alta prevalência dessas infecções, sugerindo necessidade de atenção individualizada e qualificada, com vistas à sua redução. Assim, os dados da presente investigação podem proporcionar à Enfermagem e a outros profissionais de saúde elementos que facilitem a sistematização do cuidado a esse grupo populacional, permitindo intervenções que considerem as três dimensões da vulnerabilidade, implicando maior potencial de transformação do processo-saúde-doença. / Vulnerability is the possibility of exposing oneself to illness, considering individual and collective factors, divided into three articulated analytical dimensions: individual, social and programmatic. In women who have sex with women (MSM), vulnerability to sexually transmitted infections (STI) is based on issues of struggle for social and political visibility, gender difference, heteronormative pattern, health care unpreparedness and lack of knowledge about STI /aids prevention, which has been little explored in the national scenario. Objective: To analyze the vulnerability of women who have sex with women to STI /aids. Method: A cross-sectional (transversal) study integrating a broader research project related to MSM access to health services and sexual and reproductive health. The sample of 150 MSM residents in countryside of Sao Paulo province was constituted by means of the snowball sampling technique, in a referral chain among healthcare professionals and LGBT leadership (Lesbian, Gay, Bisexual, Transvestite and Transsexual) and by spontaneous demand, from the disclosure of the Project in social networks, media, health services and activism groups. The variables studied in the present research were classified according to the theoretical reference of vulnerability. The data were obtained from January 2015 to March 2017 through the application of questionnaires, gynecological examinations and peripheral blood collections. For the diagnosis of human papillomavirus infections, Chlamydia trachomatis and Neisseria gonorrhoeae, the polymerase chain reaction was used to confirm HIV (Human Immunodeficiency Virus), ELISA and Western blot tests, for Hepatitis B the ARCHITECT HBsAg assay. For syphilis diagnosis, women whose treponemal and VDRL reagent test or the two treponemics positive, without a history of adequate pretreatment, was considered a reagent result. The identification of Trichomonas vaginalis occurred from the staining of cervical smear. Descriptive statistics were used for analysis of the data and associations were verified by multiple logistic regression and comparisons, using Mann-Whitney test, of the vulnerability score between women with and without a history of sexual intercourse with men. Results: The median age of the MSM investigated was 26 years (18-62), 74.7% were white, 73.3% single, 51.3% were school educated for 12 or more years, 74% were employed or self-employed and 50.7% had per capita family monthly income greater than R $ 1,019.00. The majority had a history of sexual intercourse with men during their lifetime (74.7%), however, in the last twelve months, only 21.3% had sexual intercourse with men. The diagnosis of some STI was found in 47.3% of the women. Multivariable logistic regression analysis showed only variables of individual dimension independently associated with STI /aids: no serology for STI /aids [OR = 2.80 (1.13 - 6.94); P = 0.027], have a history of STI [OR = 4.00 (1.03-15.50); P = 0.045] and had had sexual intercourse with men in the last 12 months [OR = 8.65 (2.39-31.38); P = 0.001]. According to the vulnerability analysis strategy adopted, all women investigated were vulnerable, and the programmatic vulnerability was the one with the highest median vulnerability score of 9.6 (0-24) and the social, the lowest, 7.5 points (0-19). Women with or without a history of sexual intercourse with men in their life did not differ on the vulnerability score in social and programmatic dimensions; and those who have sexual intercourse with men in their life had a higher score in the individual dimension [10,0 (4,0-17 , 0 vs. 8.0 (4.0-13.0), and p = 0.001. Moreover, MSM that had a relationship with men in the last 12 months had a higher individual and social vulnerability score than those without this history [12.0 (6.0-17.0) vs. 9.0 (4.0-15.0), p = 0.000 and 10.0 (0.0-19.0) vs. 5.0 (0.0 - 14.0); p=0.042, respectively] without programmatic vulnerability score differences. Conclusion: The MSM investigated presented high vulnerability to STI /aids in all three dimensions, confirmed by the high prevalence of these infections. This outcome suggests the need for individualised and qualified healthcare programme aiming the reduction of MSM vulnerability. Therefore, the results of the present investigation can provide nurse-led care and other healthcare professionals criteria to facilitate the systematization of care to this group, allowing interventions that consider the three dimensions of vulnerability, contributing in great potential, for transformation of the health-disease process. / FAPESP: 2015/14769-0

Introduction: Emerging adults (young people age 18 to 29) are increasingly using the Internet to seek sex partners, with over 30% having tried an online or mobile dating site. As more emerging adults use dating and sex-seeking websites (DSP) for their love and sexual pursuits, it is imperative to understand how DSPs contribute to HIV/STI risk. Objectives: The objectives of this research were accomplished by pursuing the following specific aims: Aim 1. To systematically review and quantitatively synthesize evidence from published findings to determine the association between condom use and meeting venue (online and offline). Aim 2. To determine whether condom use behaviors during the first sexual interaction among heterosexual emerging adults vary depending on the venue in which participants met their partners in the past six months. Aim 3. To describe how the Information Motivation Behavioral (IMB) Skills Model applies to the relationship between condom use and meeting venue. Methods: This mixed methods study identified sexual risk behaviors of emerging adults. Men and women—recruited via social networking, classified ad and dating and sex-seeking websites— who met a heterosexual partner on a DSP and/or in-person in the past six months completed a survey about behavioral, communication and relationship factors that influence condom use. Additionally, a subset of people who met partners on DSPs and or offline (i.e., in-person) who completed the survey participated in qualitative interviews designed to explore in-depth factors that influence condom use during the first offline sexual encounter. The Information Motivation Behavioral (IMB) skills model was used to further understand the HIV/STI sexual risk behaviors of emerging adults with sex partners they met on DSP compared to those who met partner’s offline. Results: The findings of this study were that DSP are not associated with greater risks of condomless sex compared to offline meeting venues. The qualitative findings suggest that emerging adults have an attitude that condoms are to be used in new sexual relationships. However, whenever emerging adults do not have condoms available, they are less likely to use a condom. Conclusion: Although the findings of this study suggest that there is no statistical difference in condomless sex by venue, DSPs are an important place for public health messaging about condom use for the prevention of HIV/STIs, and unintended pregnancy. DSPs can help achieve some of the objectives set by Healthy Campus 2020, Healthy People 2020, and the National HIV/AIDS Strategy. In addition to targeting DSPs, it is important to continue sexual health promotion efforts in offline meeting venues.