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.

This thesis presents data on incidence and risk factors for individual sexually transmissible infections (STIs) and STIs as risk factors for HIV acquisition in a community-based cohort of HIV negative homosexual men in Sydney. Nearly half of men aged under 25 years were seronegative to hepatitis A and B infection. The prevalence of hepatitis C (HCV) was 0.85%, which was close to that of the general population. HCV infection was strongly associated with injecting drug use (OR 60.43, 95% CI 6.70-544.79), and sexual transmission was not demonstrated in this cohort. There was a nearly 40 fold increase in syphilis notifications in inner Sydney between 1999 and 2004. The stable incidence of 0.6% per year in the HIM cohort suggests that it was disproportionately affecting HIV positive men. Oral sex was an important transmission route and about one third of cases were asymptomatic. The incidence of urethral and anal gonorrhoea was 3.78 and 3.19 per 100 person-years, and for urethral and anal chlamydia it was 7.98 and 5.20. In addition to unprotected anal intercourse (UAI), insertive oral sex was related to urethral infections and anal infections were associated with non-intercourse anal sexual practices. The prevalence of herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) was 75% and 23% respectively. Sexual contact not only with men, but with women, was significantly associated with both infections. Among those susceptible at baseline, the incidence for HSV-1 and HSV-2 was 5.58 and 1.45 per 100 person-years. Oral sex was associated with incident HSV-1 infection and certain non-intercourse anal sexual practices were significantly associated with incident HSV-2 infection. HIV incidence was 0.94 per 100 person-years. It was significantly associated with a higher number of episodes of receptive UAI with a partner of unknown HIV status (p trend&lt0.001) or a partner known to be HIV positive (p trend&lt0.001). After controlling for sexual behaviour, HIV seroconversion was significantly associated with anal gonorrhoea (HR 12.68, 95% CI 3.66-44.00). The association with anal warts and prevalent HSV-1 infection was of borderline significance. These data will inform intervention designs targeting STIs which aim to prevent HIV in homosexual men.

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.

xv, 179 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (M.D.)--University of Adelaide, Dept. of Medicine, 1974

Studies from developing countries disagree on whether mobility is a risk factor or a protective factor for HIV risk. The difference is often determined by gender. Few studies exist, however, examining the relationship among high risk populations in developed nations. This study seeks to examine that relationship in 10 high risk ZIP codes of Atlanta, Georgia using data gathered from the Geography Project by Rothenberg and colleagues. Logistic regression was used to examine the relationship between HIV risk and five independent variables of mobility. Results were stratified by gender. After controlling for demographic and behavioral variables, use of public transportation by men was significantly protective of HIV risk. Significant associations were also observed with ever injection drug use and recent condom use, indicating that high risk behaviors may be the real driver of the epidemic in these neighborhoods.

This dissertation aims at analyzing complex problems arising in the context of dynamical networks, proteomics, and disease prevention. First, a new graph-based method for proving global stability of synchronization in directed dynamical networks is developed. This method utilizes stability and graph theories to clarify the interplay between individual oscillator dynamics and network topology. Secondly, a graph-theoretical algorithm is proposed to predict Ca2+-binding site in proteins. The new algorithm enables us to identify previously-unknown Ca2+-binding sites, and deepens our understanding towards disease-related Ca2+-binding proteins at a molecular level. Finally, an optimization model and algorithm to solve a disease prevention problem are described at the population level. The new resource allocation model is designed to assist clinical managers to make decisions on identifying at-risk population groups, as well as selecting a screening and treatment strategy for chlamydia and gonorrhea patients under a fixed budget. The resource allocation model and algorithm can have a significant impact on real treatment strategy issues.

Syfte: Undersöka preventivmedelsanvändning, sexuellt riskbeteende gällande könssjukdomar och oönskade graviditeter samt skillnader i sexuellt riskbeteende mellan olika ursprung, självförtroende och ålder vid sexuell debut hos kvinnor i åldern 14-31 år. Metod: En enkätundersökning, konsekutivt urval, utförd på RFSU-kliniken under år 2011 inkluderade 419 kvinnor. Resultat: Kondom var det vanligaste preventivmedlet vid första samlaget och p-piller var vanligast vid senaste samlaget. Nästan hälften, 48,7 %, hade haft en könssjukdom, klamydia var vanligast. Över hälften, 60,2 %, hade riskerat att få en könssjukdom och 45,6 % hade riskerat att bli oönskat gravid under de senaste tolv månaderna. Den främsta anledningen till detta var på grund av att de struntade i kondom ”i stundens hetta”. Kvinnor som haft sin sexuella debut i yngre ålder angav oftare att de haft en könssjukdom och någon gång under de senaste tolv månaderna riskerat att bli oönskat gravid. Kvinnor som skattat sitt självförtroende som högt struntade oftare i att använda kondom ”i stundens hetta”. Slutsats: Över hälften hade ett sexuellt riskbeteende gällande könssjukdomar och oönskade graviditeter. Kvinnor som hade sin sexuella debut i yngre ålder samt kvinnor som skattade sitt självförtroende högt visade oftare på ett sexuellt riskbeteende. Det fanns ingen signifikant skillnad mellan svenskfödda och utlandsfödda gällande ett sexuellt risktagande. / Aim: Investigate contraceptive use, sexual risk behavior regarding sexually transmitted diseases (STD’s) and unwanted pregnancies and examine differences in sexual risk behavior regarding different backgrounds, self-confidence and age at first intercourse in women aged 14-31 years. Method: Consecutive sample including 419 women with a questionnaire, at a RFSU-clinic in Stockholm, 2011. Results: Condoms were most common at first intercourse and oral contraceptives most common at latest intercourse. Almost half had had an STD, Chlamydia the most common. Almost 60 % risked getting STD’s and 45,6 % risked unwanted pregnancies at sometime during the last twelve months. Main reason why participants risked this was because they ignored the condom in “the heat of the moment”. Women who had their first intercourse at a young age more often have had an STD and during the last twelve months risked an unwanted pregnancy. Women with a high self-confidence more often ignored using a condom in “the heat of the moment”. Conclusion: Over half of the participants had a sexual risk behavior regarding STD’s and unwanted pregnancies. Women who had their first intercourse at a young age and women with a high self-confidence showed signs of sexual risk-taking. There’s no significant difference between Swedish born and foreign born participants regarding sexual risk-taking.

No description available.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

Thesis (M. Med. Sc.)--University of Hong Kong, 2000. / Includes bibliographical references (leaves 35-42).