Tendencias temporales en el uso de métodos de barrera durante las relaciones sexuales en Argentina y eficacia de intervenciones para promover su implementación / Trends in the use of barrier methods during sexual intercourse in Argentina and the effectiveness of interventions to promote their implementation

Durante la última década, presenciamos en Argentina un aumento de la incidencia de infecciones de transmisión sexual(ITS) vinculado con una disminución en el uso de métodos de barrera (MB). De acuerdo a la bibliografía, existen varias categorías de obstáculos para el uso de MB: desigualdades de género, dificultades económicas y/o de accesibilidad, desconfianza respecto de los MB provistos por el Estado respecto de su calidad y/o fecha de vencimiento, o bien, creencias acerca de que la utilización de MB disminuye el placer sexual o que no es necesario su uso cuando la relación de pareja es estable y/o basada en la confianza, el amor y/o la fidelidad. A partir de esta problemática, los autores de este artículo realizamos una búsqueda bibliográfica y revisamos cual es la evidencia que respalda diferentes intervenciones para promover el uso de MB. Encontramos evidencia de moderada calidad que avala la eficacia de intervenciones a nivel comunitario basadas en la teoría sociocognitiva y en el aumento de la oferta y la disponibilidad de preservativos para mejorar el conocimiento sobre el HIV y el uso de estos métodos, sin impacto sobre la incidencia de ITS a nivel poblacional. (AU)

Over the last decade, Argentina has shown an increase in the incidence of sexually transmitted infections (STIs) linked to a decrease in the use of barrier methods (BM). According to the literature, there are several categories of obstacles for the use of BM: gender inequalities, economic and/or accessibility difficulties, mistrust regarding the quality and/or expiry date of state-provided BMs, as well as beliefs that the use of BMs reduces sexual pleasure or that their use is not necessary when the couple's relationship is stable and/or based on trust, love and/or fidelity. In light of this issue, the authors of this article conducted a literature search and reviewed the evidence supporting different interventions to promote the use of BM. They found moderate quality evidence that supports the efficacy of community-level interventions based on socio-cognitive theory and on increasing the supply and availability of condoms to improve knowledge about HIV and the use of these methods, with no impact on the incidence of STIs at the population level. (AU)

Prevalência do uso do preservativo por trabalhadores da construção civil e fatores associados / Prevalence of condom use among construction workers and associated factors / Prevalencia del uso de condón por los trabajadores de la construcción y factores relacionados

Objetivo: estimar a prevalência do uso do preservativo e os fatores associados em trabalhadores da construção civil. Método: estudo transversal, analítico, com 370 trabalhadores da grande João Pessoa, Paraíba. Considerou como variável de desfecho o uso do preservativo na última relação sexual. Utilizou-se questionário estruturado. Análise de regressão logística bivariada e múltipla foi utilizada para identificar associação entre as variáveis sociodemográficas e o uso do preservativo. Resultados: a maioria dos participantes é do sexo masculino, adultos jovens, casados e com baixa escolaridade. A prevalência estimada de uso do preservativo foi de 23,5% (IC 95%: 19,2% - 27,8%). Indivíduos com menos de 39 anos possuem 1,82 vezes mais chances de usar o preservativo e ser casado diminui (RC=0,26) as chances de uso. Conclusão: há baixa prevalência de uso do preservativo em trabalhadores da construção civil. A prevenção combinada é uma alternativa para controle das infecções transmissíveis, sendo o preservativo o principal coadjuvante.

Objective: to estimate the prevalence of condom use and the associated factors in construction workers. Method: in this crosssectional, analytical study with 370 workers from greater João Pessoa, Paraíba, Brazil, the outcome variable was condom use at last sexual intercourse. A structured questionnaire was used. Bivariate and multiple logistic regression analysis was used to identify associations between sociodemographic variables and condom use. Results: most participants were young, male adults, married and with little education. Estimated prevalence of condom use was 23.5% (95% CI; 19.2% - 27.8%). Individuals under 39 years old were found to be 1.82 times more likely to use condoms than individuals aged 40 years or older (OR = 1.82; 95% CI), while being married reduced the likelihood (OR = 0.26). Conclusion: prevalence of condom use is low among construction workers. Combined prevention is one option for controlling communicable diseases, with condoms as the main support.

Objetivo: estimar la prevalencia del uso de condón y los factores asociados en trabajadores de la construcción. Método: en este estudio transversal y analítico con 370 trabajadores del área metropolitana de João Pessoa, Paraíba, Brazil, la variable de resultado fue el uso de condón en la última relación sexual. Se utilizó un cuestionario estructurado y análisis de regresión logística bivariada y múltiple para identificar asociaciones entre las variables sociodemográficas y el uso del condón. Resultados: la mayoría de los participantes fueron jóvenes, varones adultos, casados y con poca educación. La prevalencia estimada del uso de condones fue del 23,5% (IC del 95%; 19,2% - 27,8%). Se encontró que las personas menores de 39 años tenían 1,82 veces más probabilidades de usar condones que las personas de 40 años o más (OR = 1,82; IC del 95%), mientras que estar casado redujo la probabilidad (OR = 0,26). Conclusión: la prevalencia del uso de condones es baja entre los trabajadores de la construcción. La prevención combinada es una opción para controlar las enfermedades transmisibles, con el condón como principal apoyo.

Conductas de riesgo hacia la infección por VIH. Una revisión de tendencias emergentes / Risk behaviors for HIV infection. A review of emerging trends

Resumen La infección por VIH, adquirida con participación consciente del receptor, es un problema complejo de alcance mundial, particular entre hombres que tienen sexo con otros hombres. Emergen comportamientos como el Bareback (sexo anal sin protección de modo intencional entre hombres) y, Bugchasing (sexo bareback cuando uno de los participantes es VIH+ y el otro no). Se caracterizó un grupo de conductas emergentes de riesgo hacia la infección por VIH. Se realizó una revisión bibliográfica en las bases de datos Medline, Web of Sciences, y Scielo regional. Se utilizaron términos de búsqueda como, sexo sin protección, Barebacking/Bareback, y Bug chasing, todos relacionados al VIH. Las conductas Barecack, y Bug Chaser se producen entre otros factores por el Homonegativiso social, la cobertura positiva de la Terapia Antirretroviral, campañas de prevención insuficientes, búsqueda de nuevas sensaciones, y el intento de fortalecer la relación con un miembro de la pareja VIH+. El sexo sin protección por su parte se asocia principalmente a tener diagnóstico de VIH/sida, violencia física debido a la orientación sexual, asistir a sitios de sexo Gay y haber comprado o vendido sexo. Se debe trabajar con los comportamientos individuales que acercan al sujeto a la infección.

Abstract HIV infection, acquired with the conscious participation of the recipient, is a complex problem of international concern, especially among men who have sex with men. Behaviors emerge such as bareback (intentionally unprotected anal sex between men) and bugchasing (bareback sex when one participant is HIV+ and the other is not). A group of emerging risk behaviors for HIV infection was characterized. A review of the literature in the MEDLINE, Web of Science and regional SciELO databases was performed. HIV-related search terms such as unprotected sex, barebacking/bareback and bug chasing, were used. Bareback and bug chaser behaviors occur, among other factors, through social homonegativity, ART positive coverage, insufficient prevention campaigns, search for new sensations and attempts to strengthen the relationship with the HIV+ member. Unprotected sex is primarily associated with having HIV/AIDS diagnoses, physical violence due to sexual orientation, viewing homosexual sex sites, and having bought or sold sex. It is necessary to work with individual behaviors that draw individuals close to infection.

Alcohol misuse among women in Brazil: recent trends and associations with unprotected sex, early pregnancy, and abortion

Objective: This study compared the rates of binge drinking (BD) and alcohol use disorder (AUD) reported for 2006 with those reported for 2012, exploring their associations with unprotected sex, early pregnancy, and abortion in a representative sample of women in Brazilian households. Methods: This was a descriptive analysis of data from a cross-sectional study involving randomized multistage cluster sampling of the population ≥ 14 years of age. Weighted prevalence rates and odds ratios were estimated, and serial mediation analysis was performed. Results: A total of 4,256 women were analyzed. The BD prevalence was 35.1% and 47.1% in 2006 and 2012, respectively, a significant increase, especially among women 40-59 years of age. There was no significant difference in AUD prevalence. BD (without AUD) was found to increase the odds of unprotected sex and abortion. The path analysis showed that early pregnancy was a mediator of the relationship between alcohol consumption and abortion. Conclusion: Among women in Brazil, the harmful use of alcohol is increasing, which has an impact on female reproductive health and exposure to risks. There is a need for specific prevention initiatives focusing on alcohol-related behaviors in women.

Vulnerability of women with human immunodeficiency virus to cervical cancer / Vulnerabilidad de las mujeres con virus de la inmunodeficiencia humana al cáncer de cérvix / Vulnerabilidade das mulheres com vírus da imunodeficiência humana ao câncer de colo do útero

Abstract Objective: To identify the vulnerabilities of women with human immunodeficiency virus to cervical cancer. Methods: Cross-sectional study carried out in a clinic with 152 adult women with HIV, by means of the application of a structured form comprising several types of vulnerability. Results: Related to individual vulnerability, were prevalent the age above 29 years (87.5%), education higher than eight years of study (53.3%) and family income lower than two minimum wages (94.1%). The majority reported active sexual life (81.6%) and non-use of condoms (57.2%). Regarding the social vulnerability, 56.6% were unemployed. About programmatic vulnerability, 44.0% of women underwent a prevention exam in a period of more than one year. Women with more schooling (p = 0.007), employed (p = 0.000) and that did not use illicit drugs (p = 0.000) underwent the preventive exam in proper frequency. Conclusion: In this study, were identified individual, social and programmatic vulnerabilities for cervical cancer in women with HIV.

Resumen Objetivo: Identificar las vulnerabilidades de mujeres con virus de la inmunodeficiencia humana para el cáncer de cérvix. Método: Estudio transversal desarrollado en centro de salud con 152 mujeres con HIV a partir de formulario estructurado envolviendo los tipos de vulnerabilidad. Resultados: Para la vulnerabilidad individual, eran predominantes mujeres con edad superior a 29 años (87,5%), escolaridad superior a ocho años (53,3%) y renta de la unidad familiar menor que dos salarios mínimos (94,1%). La mayoría informó vida sexual activa (81,6%) y no uso del preservativo (57,2%). Sobre la vulnerabilidad social, 56,6% estaban desempleadas. Para vulnerabilidad programática, 44,0% realizaron exámenes preventivos en periodo superior a un año. Mujeres con más escolaridad (p = 0,007), empleadas (p = 0,000) y que no usaban drogas ilícitas (p = 0,000) realizaban exámenes preventivos en la frecuencia adecuada. Conclusión: Se identificaron situaciones de vulnerabilidades individual, social y programática para el cáncer de cérvix en las mujeres con VIH de ese estudio.

Resumo Objetivo: Identificar as vulnerabilidades das mulheres com vírus da imunodeficiência humana ao câncer de colo do útero. Método: Estudo transversal desenvolvido em ambulatório com 152 mulheres adultas com HIV, a partir de formulário estruturado envolvendo os tipos de vulnerabilidades. Resultados: Para a vulnerabilidade individual, foram predominantes a faixa etária maior que 29 anos (87,5%), com escolaridade maior que oito anos de estudo (53,3%) e renda familiar menor que dois salários mínimos (94,1%). A maioria informou vida sexual ativa (81,6%) e não utilização de preservativo (57,2%). Para vulnerabilidade social, 56,6% estavam desempregadas. Na vulnerabilidade programática, 44,0% das mulheres realizaram exame de prevenção em período superior a um ano. Mulheres com maior escolaridade (p = 0,007), empregadas (p = 0,000) e que não usavam drogas ilícitas (p = 0,000) realizavam exames preventivos na frequência adequada. Conclusão: Neste estudo, foram identificadas situações de vulnerabilidades individual, social e programática para câncer de colo do útero nas mulheres com HIV.

Desafios para as políticas públicas voltadas à adolescência e juventude a partir da Pesquisa Nacional de Saúde do Escolar (PeNSE) / Challenges for public policies aimed at adolescence and youth based on the National Scholar Health Survey (PeNSE)

Resumo O objetivo do artigo é analisar os principais problemas e desafios para a implementação de políticas públicas voltadas para a adolescência brasileira a partir de revisão narrativa dos resultados da Pesquisa Nacional de Saúde do Escolar (PeNSE). Ensaio teórico sobre políticas públicas produzido a partir de revisão narrativa das três edições da PeNSE. Os artigos identificados foram categorizados em temas prioritários para intervenção de políticas públicas. Tabagismo: estável quanto ao cigarro e aumento de 18% de outros produtos do tabaco. Álcool: consumo regular caiu de 27,3% para 23,2%. Drogas: aumento da experimentação, a supervisão familiar mostrou-se protetora para uso de tabaco, álcool e drogas. Aumento de todos os indicadores de violência. Predomínio de hábitos não saudáveis: apenas 20% dos escolares praticam 1 hora de atividade física ou mais diariamente. Sexualidade: redução do uso preservativos na primeira relação. Serviços de saúde: metade dos escolares usaram nos últimos 12 meses. A exposição de fatores de risco como álcool, sexo inseguro e práticas e condições violentas é elevada na adolescência. Torna-se importante a adoção de políticas públicas e ações intersetoriais, plurais e abertas à singularidade, voltadas para a proteção da saúde de adolescentes e jovens.

Abstract Objective to examine the problems and challenges facing implementation of policies for Brazilian adolescents, on the basis of narrative review of the findings of the National Survey of School Health (PeNSE). Methods theoretical policy analysis based on narrative review of the three editions of the PeNSE. The articles identified were categorised by priority issues for public policy intervention. Results cigarette smoking held stable, while use of other tobacco products increased by 18%. Regular alcohol use declined from 27.3% (2009) to 23.2% (2015). Drug experimentation increased, while family supervision produced protective effects against tobacco, alcohol and drug use. All indicators of violence increased, including involvement in fights where someone used a firearm or melee weapon. Diet and physical activity displayed predominantly unhealthy habits: (only 20% exercised for an hour or more daily). Sexuality: condom use at first intercourse decreased from 75.9% to 66.2%. Half the students had used a health service in the prior 12 months. Conclusion exposure to risk factors, including alcohol, unsafe sex and violent behaviour and conditions, is high in adolescence, making it important to adopt public policies and inter-sectoral actions that are plural and open to singularity in order to protect the health of adolescents and youth.

Associação entre as condutas de risco do uso de álcool e sexo desprotegido em adolescentes numa cidade do Sul do Brasil / Association between the risk of alcohol use and unprotected sex in adolescents in a city in the southern region of Brazil

Resumo O objetivo deste artigo é analisar as condutas de uso abusivo de álcool e sexo desprotegido e a associação entre ambos em escolares numa cidade do Sul do Brasil. Trata-se de um estudo transversal e de abordagem quantitativa com 590 alunos do Ensino Médio em duas escolas públicas. Quanto ao uso do álcool, 14% pontuaram de 8 a 40 no The Alcohol Use Disorders Identification Test (AUDIT), o que significa, no mínimo, uma conduta de beber de risco, com índice maior entre rapazes. Além disso, 31,1% beberam de modo a se embriagar, o que significa beber 6 ou mais doses, segundo o AUDIT; e, mesmo dentre aqueles que são bebedores de baixo risco, 21,1% tiveram esse padrão de beber. Em relação ao comportamento sexual, os rapazes iniciaram o intercurso sexual mais precocemente e o tipo de relacionamento mais referido foi o ficar; os rapazes ficam, e as moças namoram mais. Quanto ao resultado da associação entre uso de álcool e relação sexual, 47,3% declararam já ter usado álcool antes de ter relações sexuais e aqueles que iniciaram a atividade sexual se embriagaram mais e tiveram maior pontuação no AUDIT. Recomendam-se novos estudos a respeito da associação entre ambas as condutas no Brasil, já que a relação causal não é clara e apresenta diversos modelos de explicação.

Abstract This paper aims to analyze alcohol abuse and unprotected sex and the association between them in students in a city in the southern region of Brazil. This is a cross-sectional study using a quantitative approach with 590 secondary school students from two public schools. Regarding alcohol use, 14% scored from eight to 40 in The Alcohol Use Disorders Identification Test (AUDIT), which means, at least, a risky drinking behavior, with higher rate among boys. Moreover, 31.1% indulged themselves in binge drinking, which means drinking six or more doses according to AUDIT; and even among those who are low- risk drinkers, 21.1% had this drinking pattern. Regarding sexual behavior, young boys started sexual life earlier and the kind of relationship more referred to by them is one with no commitment; boys have uncommitted relationships, while girls have more relationships with commitment. In relation to the results of the association between alcohol use and sexual intercourse, 47.3% stated alcohol use before having sex, and those who started sexual activity got more drunk and had higher scores in the AUDIT. New studies are recommended regarding the association between both behaviors in Brazil, considering that the causal relationship is not clear and shows several explanation models.

Condom use and alcohol consumption in adolescents and youth / Uso de preservativo e consumo de bebida alcoólica em adolescentes e jovens escolares

ABSTRACT Objective To determine the association between not using the male condom and alcohol consumption in adolescents and schoolchildren. Methods An epidemiological study, with a cross-sectional, descriptive, and correlation design carried out from March to July 2014. The sample consisted of students in public primary and secondary education, aged between 12 and 24 years. The social and demographic survey and the Youth Risk Behavior Survey questionnaire were used. Results The study included 1,275 students, of these; 37.0% reported having had sexual relations. The prevalent age of sexual initiation was 14-16 years 55.7% and 65.6% used condom in the last sexual intercourse. Regarding the lack of condom use at the last intercourse, girls showed an association with drunkenness in the previous 30 days (2.19; 95%CI: 1.06-4.54). Conclusion In females, the non-use of condoms was associated with drunkenness in the previous 30 days.

RESUMO Objetivo Identificar os fatores associados ao não uso de preservativo masculino e ao consumo de bebida alcoólica em adolescentes e jovens escolares. Métodos Estudo epidemiológico, com delineamento transversal, descritivo e correlacional, desenvolvido de março a julho de 2014. A amostra foi composta por estudantes dos Ensinos Fundamental e Médio da rede pública estadual, com idades entre 12 e 24 anos. Empregaram-se o inquérito sociodemográfico e o questionário Youth Risk Behavior Survey. Resultados Foram incluídos 1.275 estudantes; 37,0% deles relataram terem tido relação sexual. A idade prevalente de iniciação sexual foi de 14 a 16 anos, com 55,7%; 65,6% usaram preservativo na última relação. Com relação ao não uso de preservativo na última relação, as meninas apresentaram associação com bebedeira nos últimos 30 dias (2,19; IC95%: 1,06-4,54). Conclusão O não uso de preservativos esteve associado com bebedeira nos últimos 30 dias nas meninas.

Restituição dos dados na pesquisa etnográfica em saúde: questões para o debate a partir de experiências de pesquisas no Brasil e França / Restitution of the research data in ethnographic health research: issues for debate based on field research conducted in Brazil and France

ResumoO presente texto apresenta aspectos pertinentes à restituição dos dados da pesquisa antropológica aplicada à saúde, a partir do relato de experiências de pesquisas etnográficas realizadas no Brasil e na França. Tais experiências mostram que a restituição dos dados fez parte do escopo da pesquisa, com modalidades e temporalidades diversas, permitindo prolongar o tempo de trabalho de campo e as interações com os indivíduos pesquisados. Da mesma forma, possibilitou trocas entre os interlocutores e confrontos de diferentes pontos de vista, trazendo novos dados e, assim, enriquecendo as pesquisas. Esses aspectos suscitaram questões importantes para reflexão, do ponto de vista ético e epistemológico. Uma delas diz respeito às demandas feitas aos antropólogos da saúde no momento de inserção do campo e como as mesmas serão por eles tratadas: como o pesquisador restituirá os dados, sem receio de vê-los ser mal interpretados ou instrumentalizados de forma a reforçar padrões normativos? Nesse sentido, como “traduzir” o discurso antropológico? O pesquisador consciente busca validar suas análises, busca novos pontos de vista e interrogações. Assim, a restituição provoca novas inquietações e interpretações na forma de reflexividade.

AbstractThis study examines relevant aspects about the way anthropological research data restitution has been applied in the area of health, based on data obtained from ethnographic field research conducted in Brazil and France. These experiences show that data restitution has been part of the area of research, in different forms and time frames, making it possible to extend periods spent in the field and to interact with individual respondents. This also made it possible to interact with research interlocutors and compare different points of view, adding new information and thereby enriching the research. These aspects raise important questions that require reflection, from an ethical and epistemological standpoint. One is related to the demands made on health anthropologists when they begin their field research and how they deal with these questions: how will researchers use the data they collect without worrying that this may be wrongly interpreted or used in some way to reinforce normative patterns? So, how should an anthropological debate be “translated”? Conscientious researchers will seek to validate their analysis, to discover new points of view and provoke new lines of questioning. Thus, such data should provoke reflexivity about new avenues of research and interpretations.

Factors associated with unprotected sexual practice among men and women with mental illnesses in Brazil / Fatores associados com a prática do sexo desprotegido entre homens e mulheres com transtornos mentais no Brasil / Los factores asociados con la práctica del sexo sin protección entre hombres y mujeres con trastornos mentales en Brasil

This study estimated the rate and correlates of recent unprotected sex among sexually active psychiatric patients in Brazil, stratified by gender. The prevalence of unprotected sex among women and men were 89% and 77%, respectively. Significant correlates with unprotected sex were: being married/in union, living with children/partner, and cigarette smoking in both genders; lower income, depression and anxiety diagnoses among men only; older age, no previous HIV testing, sex under the influence of alcohol/drugs, and verbal violence among women only. Interventions to reduce risk behavior among psychiatric patients in Brazil are urgent and should take into account gender differences.

Este estudo estimou a prevalência e os fatores associados com o sexo desprotegido recente entre pacientes psiquiátricos sexualmente ativos no Brasil, estratificados por sexo. A prevalência de sexo desprotegido entre mulheres e homens foi 89% e 77%, respectivamente. Os fatores associados significativamente com o sexo desprotegido foram: estar casado/em união, viver com filhos/parceiros, e tabagismo em ambos os sexos; baixa renda e diagnósticos de depressão e ansiedade apenas entre homens; idade maior que 40 anos, nenhum teste prévio para o HIV, sexo sob a influência de álcool/drogas e violência verbal apenas entre as mulheres. Intervenções para reduzir comportamentos de risco entre pacientes psiquiátricos no Brasil são urgentes e devem considerar as diferenças de gênero.

Este estudio estima la prevalencia y los factores asociados con el sexo no protegido reciente entre los pacientes psiquiátricos sexualmente activos en Brasil, estratificado por sexo. La prevalencia de relaciones sexuales sin protección entre hombres y mujeres fue de 89% y 77%, respectivamente. Los factores asociados significativamente con el sexo sin protección fueron: estar casado/en unión, vivir con los niños/pareja, y el tabaquismo en ambos sexos; bajos ingresos y diagnóstico de depresión y ansiedad entre los hombres solamente; edad mayor de 40 años, ninguna prueba anterior para VIH, sexo bajo la influencia de alcohol/drogas y la violencia verbal sólo entre las mujeres. Las intervenciones para reducir los comportamientos de riesgo entre los pacientes psiquiátricos en Brasil son urgentes y deben considerar las diferencias de género.

Correlates of unprotected sex in a sample of young club drug users

OBJECTIVES: To assess the demographic characteristics, psychiatric symptoms, substance use patterns, and sexual risk behaviors in a sample of club drug users to identify factors associated with unprotected sex during the 12 months prior to the interview. METHODS: This cross-sectional study employed the targeted sampling and ethnographic mapping approaches via face-to-face interviews conducted at bars and electronic music festivals using an adapted, semi-structured version of the Global Appraisal of Individual Needs questionnaire. The sample comprised 240 male and female young adults who had used ecstasy and/or LSD in the 90 days prior to the interview and who were not receiving treatment for alcohol or drug abuse. RESULTS: Of the 240 subjects selected (mean age: 22.9±4.5 years), 57.9% were men; of the male subjects, 52.5% reported having had unprotected sex in the previous 12 months. Of the total sample, 63.33% reported having had unprotected sex. Multivariate regression analysis showed that anal sex (PR = 1.26; 95% confidence interval (CI): 1.044-1.543; p = 0.017) and the use of alcohol/drugs to make sex last longer (PR = 1.430; 95% CI: 1.181-1.732; p<0.001) are associated with unprotected sex. CONCLUSIONS: The implementation of intervention strategies aimed at reducing sexually risky behaviors should take into consideration the specific characteristics of drug users and should include the development of safer sex negotiation skills. .

A systematic review of alcohol use and sexual risk-taking in Latin America / Revisión sistemática de la relación entre el consumo de alcohol y la toma de riesgos sexuales en América Latina

OBJECTIVE: To provide an account of published literature on the association between alcohol use and sexual risk-taking, focusing on Latin America. METHODS: A search of MEDLINE, Embase, Web of Science, LILACS, and Cochrane databases identified 561 unique articles. After excluding those that were not directly relevant, 30 studies were retained for review. RESULTS: Twenty-seven studies showed direct or indirect associations between alcohol abuse and unprotected/risky sex. Three studies, however, showed no association between these variables, suggesting that the public health message of safer sex may have been effective. CONCLUSIONS: Further research is needed to identify factors and behaviors that could be modified to reduce the association between alcohol use disorders and risky sexual behavior.

OBJETIVO: Proporcionar una descripción de la bibliografía sobre la asociación entre el consumo de alcohol y la toma de riesgos sexuales, con foco en América Latina. MÉTODOS: Una búsqueda en las bases de datos MEDLINE, Embase, Web of Science, LILACS y Cochrane permitió seleccionar 561 artículos singulares. Tras excluir los que no eran pertinentes, se retuvieron 30 estudios para su análisis. RESULTADOS: Veintisiete estudios revelaron asociaciones directas o indirectas entre el consumo excesivo de alcohol y el sexo sin protección o de riesgo. Sin embargo, tres estudios no mostraron ninguna asociación entre estas variables, lo que sugiere que las recomendaciones de salud pública en pro de una actividad sexual de menor riesgo podrían haber sido eficaces. CONCLUSIONES: Se requiere llevar a cabo nuevas investigaciones para establecer los factores y los comportamientos que podrían ser objeto de modificación para reducir la asociación entre los trastornos por consumo de alcohol y el comportamiento sexual de riesgo.

Alcohol consumption and risky sexual practices: the pattern of nursing students from the Spanish University / Consumo de alcool e praticas sexuais de risco: o padrao dos estudantes de enfermagem de uma universidade espanhola / Consumo de alcohol y practicas sexuales de riesgo: el patron de los estudiantes de Enfermeria de una universidad espanola

OBJECTIVE: to determine the prevalence of substance abuse and unsafe sexual practices and to analyze the relationship between them, in nursing students at the University of Seville. METHOD: quantitative methodological approach with a descriptive cross-sectional design. The population was composed of first year nursing students in the University of Seville, during the academic year 2010-2011 (N=510), with consecutive opportunistic sampling composed of students who attended class on the scheduled day (n=291). RESULTS: a high prevalence of alcohol consumption, and increased likelihood of not using protective measures during sexual practices when alcohol had been consumed, was present. CONCLUSION: these findings are consistent with those obtained in the same population in Brazil, and highlight the need to strengthen in the nursing curriculum, the transverse axis related to the prevention of substance abuse, especially alcohol. .

OBJETIVO: determinar a prevalência de abuso de substâncias e práticas sexuais inseguras e analisar a relação entre elas em estudantes de enfermagem da Universidade de Sevilha, Espanha. MÉTODO: abordagem metodológica quantitativa, com um delineamento transversal descritivo. A população foi constituída por estudantes do primeiro ano de enfermagem da Universidade de Sevilha, durante o ano lectivo de 2010-2011 (N=510), com amostragem oportunista consecutiva, formada por estudantes que assistiam às aulas na data prevista (n=291). RESULTADOS: alta prevalência de consumo de álcool e aumento da probabilidade de não de não serem utilizadas medidas de proteção durante as práticas sexuais, quando se consumia álcool. CONCLUSÃO: esses resultados são consistentes com aqueles obtidos em uma mesma população no Brasil e se destaca a necessidade de reforçar, no currículo de enfermagem, um eixo transversal relacionado à prevenção de abuso de substâncias, principalmente o álcool. .

OBJETIVO: determinar la prevalencia del consumo de sustancias tóxicas y de prácticas sexuales sin protección y analizar la relación entre ellas en los estudiantes de Enfermería de la Universidad de Sevilla. MÉTODO: abordaje metodológico cuantitativo con diseño descriptivo y transversal. La población la constituyo el alumnado de Enfermería de 1º de Grado de la Universidad de Sevilla durante el curso académico 2010-2011 (N=510), con muestreo oportunista y consecutivo conformado por el alumnado que acudió a clase el día programado (n=291). RESULTADOS: mostraron alta prevalencia del consumo de alcohol y aumento de la probabilidad de no utilizar medidas de protección en prácticas sexuales cuando se había consumido alcohol. CONCLUSIÓN: estos hallazgos concuerdan con los obtenidos en la misma población en Brasil y ponen de manifiesto la necesidad de fortalecer en el currículo de enfermería, un eje transversal relacionado con la prevención del consumo de sustancias tóxicas, especialmente con el alcohol. .

Sexual behavior among high school students in Brazil: alcohol consumption and legal and illegal drug use associated with unprotected sex

OBJECTIVE: Alcohol and other drug use appears to reduce decision-making ability and increase the risk of unsafe sex, leading to possible unplanned pregnancies, sexually transmitted diseases/human immunodeficiency virus/HIV transmission, and multiple sexual partners. This study aimed to test the hypothesis that risky sexual behaviors among adolescents are associated with legal and illegal drug use. METHODS: A national cross-sectional survey of 17,371 high-school students was conducted in 2010. Students were selected from 789 public and private schools in each of the 27 Brazilian state capitals by a multistage probabilistic sampling method and answered a self-report questionnaire. Weighted data were analyzed through basic contingency tables and logistic regressions testing for differences in condom use among adolescents who were sexually active during the past month. RESULTS: Approximately one third of the high school students had engaged in sexual intercourse in the month prior to the survey, and nearly half of these respondents had not used a condom. While overall sexual intercourse was more prevalent among boys, unsafe sexual intercourse was more prevalent among girls. Furthermore, a lower socioeconomic status was directly associated with non-condom use, while binge drinking and illegal drug use were independently associated with unsafe sexual intercourse. CONCLUSION: Adolescent alcohol and drug use were associated with unsafe sexual practices. School prevention programs must include drug use and sexuality topics simultaneously because both risk-taking behaviors occur simultaneously. .

Evidence on delay in sexual initiation, multiple partnerships and condom use among young people: review of Caribbean HIV behavioural studies / Evidencias sobre la demora en la iniciación sexual, las parejas múltiples, y el uso del condón entre los jóvenes: revisión de estudios de conducta en relación con el VIH en el Caribe

OBJECTIVE: To develop a Caribbean regional profile of youth sexual behaviour associated with risk of HIV. DESIGN AND METHODS: A review of sexual behaviour surveys with youth aged 15-24 years was conducted as part of the Pan American Health Organization (PAHO) HIV Caribbean Office's Review and Gender Analysis of Caribbean HIV Behavioural and Seroprevalence Studies. Studies with internationally recommended indicators were prioritized. Studies were sought via database searches and contact with researchers and National AIDS Programmes. RESULTS: Inter-country comparisons and longitudinal analyses were limited by lack of uniformity in study age groups and indicators. Data were sufficient to identify the following among 15-24-year olds: * More males than females report sexual intercourse before the age of 15 years. * More than half of sexually active youth report sex before age 16 years. * First sexual encounter is usually with someone older, with age differences larger for females. * More males than females report multiple partnerships, with 20%-76% of males reporting this in the past year. * Condom use varies widely, with no clear pattern by gender. CONCLUSION: There are substantial levels of early sexual initiation, intergenerational sex among females and multiple partnerships among males, while condom use is inconsistent. Efforts to promote delay in sexual initiation, partner reduction and consistent condom use should be supplemented with initiatives against harmful gender norms, child abuse and transactional sex and skills to negotiate safe sex. Standardization of survey methods to facilitate cross-study comparisons should continue and encompass additional risk factors such as transactional sex, gender-based violence, drug use and HIV treatment adherence.

OBJETIVO: Desarrollar un perfil regional caribeño del comportamiento sexual de la juventud en relación con el riesgo de VIH. DISEÑO Y MÉTODOS: Se realizó una revisión de los estudios del comportamiento sexual de jóvenes entre 15 y 24 años, como parte del Estudio de la Oficina de VIH de la Organización Panamericana de la Salud (OPS) para el Caribe, y el Análisis de Género de los Estudios de Seroprevalencia y Conducta en relación con el VIH en el Caribe. Se le dio prioridad a los estudios con indicadores recomendados internacionalmente. Se obtuvieron estudios mediante búsquedas de bases de datos y contactos con los investigadores y los programas nacionales de SIDA. RESULTADOS: Los análisis longitudinales y las comparaciones entre países estuvieron limitados por la falta de uniformidad en los grupos etarios y los indicadores de los estudios. Los datos fueron suficientes para identificar lo siguiente entre los jóvenes de 15 a 24 años de edad: * Más varones que hembras reportaron relaciones sexuales antes de los 15 años de edad. * Más de la mitad de los jóvenes sexualmente activos reportaron relaciones sexuales antes de los 16 años. * El primer encuentro sexual suele ser con alguien de más edad, siendo las diferencias de edad mayores para las mujeres. * Más varones que hembras reportaron relaciones de parejas múltiples; 20%-76% de los hombres reportaron este tipo de relación en el último año. * El uso del condón varía ampliamente, sin un patrón claro por género. CONCLUSIÓN: Hay niveles considerables de iniciación sexual temprana, sexo intergeneracional entre las hembras, y múltiples parejas entre los varones, mientras que el uso del preservativo es inconsistente. Los esfuerzos por promover la demora en la iniciación sexual, la reducción de parejas, y el uso sistemático del condón deberían complementarse con las iniciativas contra las normas de género perjudiciales, el abuso infantil, el sexo transaccional, y las habilidades para negociar sexo seguro. La estandarización de los métodos de encuesta para facilitar las comparaciones transversales debe continuar y abarcar otros factores de riesgo, tales como el sexo transaccional, la violencia de género, el uso de drogas, y el cumplimiento con el tratamiento del VIH.

Interpersonal competence and sex risk behaviours among Jamaican adolescents / Competencia interpersonal y comportamientos de riesgo sexual entre los adolescentes Jamaicanos

OBJECTIVE: Of particular public health concern to the Jamaican authorities is the consistently high numbers of new HIV infections among adolescents and young adults. The thrust in HIV/AIDS prevention campaigns has largely been toward an increase in knowledge and attitudes as opposed to personality variables. However, it is widely believed that persons with high interpersonal skills may be less likely to engage in sex risk behaviours. This study investigated interpersonal competence as a personality characteristic associated with sexual risk-taking among Jamaican adolescents. METHODS: A cross-sectional survey of 500 adolescents, ages 13−18 years (250 males and 250 females) from nine randomly selected secondary government schools within Kingston and St Andrew was used. The sample ensured maximum variation in age groups. The BarOn EQ-i:YV(S) was utilized to provide a measure of interpersonal competence and the Sex Risk Scale from the Adolescent Risk Inventory acted as a measure of sex risk behaviours. The Spearman's rho correlational statistic was used to investigate the hypothesis. RESULTS: Of the students surveyed, 58.6% reported that they were sexually active; 31.8% reported having multiple sexual partners and 28.2% reporting inconsistent condom use. A significant, inverse relationship was observed between interpersonal competence and sex risk behaviours (p < 0.05). CONCLUSION: This research provided evidence that adolescents with high interpersonal skills are less likely to participate in risky sexual behaviours. Therefore, interventions aimed at reducing risky adolescent sexual practices might benefit from the inclusion of strategies to build interpersonal skills.

OBJETIVO: De interés particular para las autoridades jamaicanas de la salud pública es el número consistentemente alto de nuevas infecciones de VIH entre adolescentes y adultos jóvenes. El desempeño principal de las campañas de prevención del VIH/SIDA ha estado dirigido en gran parte hacia el aumento de conocimientos y actitudes, en vez de a variables de la personalidad. Sin embargo, existe la creencia ampliamente extendida de que las personas con buen desarrollo de sus habilidades interpersonales, serán menos propensas a involucrarse en conductas de riesgo sexual. Este estudio investigó la competencia interpersonal como una característica de personalidad asociada con riesgos sexuales entre adolescentes jamaicanos. MÉTODOS: Se llevó a cabo un estudio transversal de 500 adolescentes, con edades entre 13−18 años (250 varones, y 250 hembras) de nueve escuelas secundarias del gobierno, seleccionadas al azar en las áreas de Kingston y Saint Andrew. La muestra garantizó una máxima variación en los grupos de edad. Se usó el test BarOn EQ-i:YV (S) para obtener una medida de la competencia interpersonal, en tanto que la Escala de Riesgo Sexual del Inventario de Riesgo Adolescente actuó como una medida de los comportamientos de riesgo sexual. Las estadísticas correlaciónales de Spearman fueron utilizadas para investigar la hipótesis. RESULTADOS: De los estudiantes encuestados, 58.6% informó estar sexualmente activos; 31.8% informó tener múltiples parejas sexuales, y el 28.2%, reportó un uso sistemático del condón. Se observó una relación inversa significativa entre la competencia interpersonal y las conductas de riesgo sexual (p < 0.05). CONCLUSIÓN: Esta investigación proporcionó evidencia de que los adolescentes con alto desarrollo de habilidades interpersonales son menos propensos a participar en conductas sexuales riesgosas. Por lo tanto, las intervenciones destinadas a reducir las prácticas sexuales adolescentes riesgosas, podrían beneficiarse con la inclusión de las estrategias para desarrollar las habilidades interpersonales.

Prevalence of high-risk sexual behaviour in Jamaican adults and its relationship to sociodemographic and religious factors: findings from the Jamaica health and lifestyle survey 2007-2008 / Prevalencia del comportamiento sexual de alto riesgo en los adultos Jamaicanos y su relación con factores sociodemográficos y religiosos: hallazgos de una encuesta de 2007-2008 sobre salud y estilo de vida en Jamaica

OBJECTIVE: To estimate the prevalence of high-risk sexual behaviours among Jamaican adults and evaluate associations with sociodemographic and religious factors. METHODS: We performed a cross-sectional study, using a nationally representative sample of Jamaicans, 15-74 years old. Participants completed an interviewer-administered questionnaire including questions on sexual activity, sociodemographic factors and religious practice. Having two or more sexual partners in the past year, non-use of condoms among persons with multiple partners and a history of previous sexually transmitted infection (STI) were the high-risk characteristics considered in the analysis. We obtained crude and category specific prevalence estimates for high-risk behaviour and estimated odds ratios for association with sociodemographic and religious factors. RESULTS: Data from 2833 participants who reported on sexually activity were analysed. Approximately 25% (95% CI 22, 27) of Jamaican adults had two or more sexual partners in the past year, while 15% (95% CI 13, 17) had a past history of an STI. Approximately 6% (95% CI 5, 7) of persons with multiple partners did not use condoms during sexual intercourse. Overall, 32% (95% CI 30, 35) had any one of the three high-risk characteristics (male, 48%; female, 17%, p < 0.001). Being married, active religious practice and weekly attendance at religious meetings were associated with lower odds of high-risk sexual behaviour, while being in a visiting relationship was associated with higher odds of high-risk behaviour. CONCLUSION: A third of Jamaicans reported sexual practices that increase their risk of HIV infection. High-risk sexual behaviour was more common among men. Being married and weekly attendance at religious services were associated with lower odds of high-risk behaviour.

OBJETIVO: Determinar la prevalencia de las conductas sexuales de alto riesgo entre los adultos jamaicanos y evaluar las asociaciones con factores sociodemográficos y religiosos. MÉTODOS: Se realizó un estudio transversal, usando una muestra nacionalmente representativa de jamaicanos, de 15 a 74 años de edad. Los participantes completaron una encuesta administrada por el entrevistador, la cual incluía preguntas sobre actividad sexual, factores sociodemográficos, y práctica religiosa. El haber tenido dos o más parejas sexuales en el último año, la ausencia del uso de condones entre personas con parejas múltiples, y una historia previa de infecciones de transmisión sexual (ITS), fueron las características de alto riesgo consideradas en el análisis. Se obtuvieron estimaciones aproximadas y específicas por categorías en relación con las conductas de alto riesgo, así como estimaciones de los cocientes de probabilidades (odds ratios) con respecto a la asociación con los factores sociodemográficos y religiosos. RESULTADOS: Se analizaron los datos de 2833 participantes que informaron estar sexualmente activos. Aproximadamente 25% (95% CI 22, 27) de los adultos jamaicanos habían tenido dos o más parejas sexuales el último año, mientras que 15% (95% CI 13, 17) habían tenido una historia de ITS. Aproximadamente 6% (95% CI 5, 7) de las personas con parejas múltiples no usaron condones durante el acto sexual. En general, 32% (95% CI 30, 35) tenían alguna de las tres características de alto riesgo (varones, 48%; hembras, 17%, p < 0.001). El estar casado, tener una práctica religiosa, y asistir semanalmente a reuniones religiosas, estuvieron asociados con menores probabilidades de comportamiento sexual de alto riesgo, mientras que las relaciones de visitas ocasionales estuvieron asociadas con mayores probabilidades de conducta de alto riesgo. CONCLUSIÓN: Un tercio de la muestra representativa de jamaicanos reportó prácticas sexuales que aumentaban el riesgo de infección por VIH. La conducta sexual de alto riesgo fue más común entre los hombres. El estar casado, y asistir semanalmente a reuniones religiosas, estuvieron asociados con menores probabilidades de comportamiento sexual de alto riesgo.

Alcohol use and associated factors among adolescent students in Thailand / El uso de alcohol y factores asociados entre los estudiantes adolescentes de Tailandia

OBJECTIVE: Alcohol misuse is a relevant public health issue in Thailand. The assessment of the prevalence of alcohol use among adolescents may guide policies and programmes aimed at reducing alcohol use among this age group. METHOD: Using data from the Thailand Global School-based Student Health Survey (GSHS) 2008, we assessed the prevalence of alcohol use and the associated factors among adolescents (n = 2758). RESULTS: Overall, the prevalence of current alcohol use was 14.8% (21.2% males and 9.3% females). Variables positively associated with the outcome in multivariable analysis among boys were older age, other substance use (smoking and illicit drug use), sex in the past 12 months, physical fighting, injury in the past 12 months; and among girls, poverty, smoking, physical fighting and lack of parental or guardian connectedness. CONCLUSION: Efforts to prevent and control alcohol misuse may need to address a cluster of risk behaviours including cigarette smoking.

OBJETIVO: El abuso del alcohol es un problema de salud pública importante en Tailandia. La valoración de la prevalencia del uso de alcohol entre los adolescentes puede guiar las políticas y programas encaminados a reducir el uso del alcohol entre este grupo etario. MÉTODO: Usando datos de la Encuesta Mundial de Salud Escolar (GSHS) 2008, efectuada en Tailandia, se evaluó la prevalencia del uso del alcohol y los factores asociados, entre los adolescentes (n = 2758). RESULTADOS: En general, la prevalencia del uso del alcohol corrientemente fue 14.8% (21.2% varones y 9.3% hembras). Las variables positivamente asociadas con el resultado del análisis multivariable entre los muchachos fueron: tener más edad, uso de otra sustancia (hábito de fumar y uso ilícito de droga), sexo en los últimos 12 meses, pelea física, lesión en los últimos 12 meses. Entre las muchachas estas variables fueron: la pobreza, el hábito de fumar, la pelea física, y la falta de relación con los padres o los tutores. CONCLUSIÓN: Los esfuerzos por prevenir y controlar el abuso del alcohol entre los adolescentes pueden llevar a la necesidad de abordar una serie de comportamientos de riesgo, incluyendo el hábito de fumar.

Factores que predisponen, facilitan y refuerzan el uso del preservativo en jóvenes universitarios de Cali, Colombia / Factors predisposing, facilitating and strengthening condom use amongst university students in Cali, Colombia

Objetivos Identificar la frecuencia del uso habitual del condón y los factores que predicen, facilitan y refuerzan su uso en jóvenes universitarios. Métodos Estudio analítico de corte transversal con análisis multivariado. La muestra fue de 397 estudiantes seleccionados aleatoriamente mediante un muestreo estratificado por Facultades a quienes se les aplicó una encuesta asistida por computador denominada "Reconociendo mi salud sexual". Resultados El uso habitual de condón se da para el 33 % de la población. Los factores predisponentes para su uso habitual fueron, el tener la intención y alta autoeficacia en su uso con la pareja ocasional. Entre los factores facilitadores, el uso con la pareja habitual aumenta en 19 veces la oportunidad de utilizarlo habitualmente. El ser hombre se asoció con su uso tanto en los factores predisponentes como facilitadores. Entre los reforzantes, considerar que el condón intensifica el placer al sentirse protegidos y que entre los amigos el condón sea aceptado, se asoció a su uso habitual. En contraste, desplazar el uso del condón por otros métodos anticonceptivos disminuyó la probabilidad de usarlo habitualmente en un 60 %. Conclusión El no uso habitual del condón en las relaciones pene-ano y su desplazamiento por el uso de otro método anticonceptivo, son claras evidencias de la mayor preocupación que representa para la juventud el embarazo en comparación con las ITS. Se recomienda, la formulación y ejecución de programas que apunten simultáneamente y con igual énfasis a la prevención de embarazos, del VIH y otras ITS.

Objective Identifying condom use frequency and factors predisposing, facilitating and reinforcing its consistent use in college students. Methods This was a cross-sectional analytical study involving multivariate analysis. The sample consisted of 397 students who were randomly selected using stratified sampling by faculty who had applied a computer-assisted survey entitled, "Recognizing my sexual health." Results 33 % of the sample population reported routine condo muse. The predisposing factors for regular condo muse were the intention to use one and high self-efficacy regarding use with casual partners. Facilitating factors revealed that condom use with a habitual partner increased the opportunity to use it 19-fold. Being male was associated with its use regarding both predisposing and facilitating factors. It is worth stressing that, amongst there in forcing factors, considering that a condom intensifies pleasure by feeling protected was associated with its regular use as was the condom being accepted by friends. By contrast, abandoning condom use for other contraceptive methods reduced the probability of it being used usually by 60 %. Conclusions Non-regular condom use in penile-anal intercourse and its displacement by other contraceptive methods provided clear evidence of young people's major concern concerning becoming pregnant rather than avoiding contracting an STI. Formulating and implementing programs simultaneously aimed at and placing equal emphasis on avoiding pregnancy and preventing HIV and other STI is recommended.