Early initiation of sexual activity: a risk factor for sexually transmitted diseases, HIV infection, and unwanted pregnancy among university students in China.

BACKGROUND: To explore any association between the timing of the initiation of sexual activity and sexual behaviors and risks among university students in China. METHODS: Data were derived from a cross-sectional study on sexual behavior among university students conducted in Ningbo municipality, China, at the end of 2003. Students completed a self-administered, structured questionnaire. Of 1981 sexually active male students, 1908 (96.3%) completed the item for timing of the initiation of sexual activity and were included in bivariate trend analyses and multiple logistic regression analyses to compare the association between this timing and sexual behavior and risks. RESULTS: Male early sexual initiators had a significantly higher risk profile, including a significantly higher proportion reporting non-regular partners (i.e., casual or commercial partners), multiple partners, diagnosis with a sexually transmitted disease (STD), partner history of pregnancy, partner history of induced abortion, and less condom and oral contraceptive use, compared with late initiators. Multivariate analyses confirmed the increased likelihood of these risks in early initiators versus late initiators, other than partner type during the last year. CONCLUSION: Our results showed that, compared to late initiators, people who initiated sexual activity early engaged in more risky behaviors that could lead to elevated risks of unwanted pregnancies and STDs or human immunodeficiency virus infection. Sex-education strategies should be focused on an earlier age, should include advice on delaying the age of first sexual activity, and should target young people who continue to take sexual risks.

HIV-related risk behaviours and the correlates among rickshaw pullers of Kamrangirchar, Dhaka, Bangladesh: a cross-sectional study using probability sampling.

BACKGROUND: National HIV serological and behavioural surveillance of Bangladesh repeatedly demonstrated a very high proportion of rickshaw pullers in Dhaka city, having sex with female sex workers (FSWs) and using illicit substances. However, no study has been conducted to identify the correlates of having sex with FSWs among this population. This study aimed to describe behavioural profile of rickshaw pullers in Dhaka city using probability samples and to identify the correlates for having sex with FSWs in order to focus HIV prevention intervention. METHODS: Six hundred rickshaw pullers were randomly selected from rickshaw garages in the Kamrangirchar area, the single largest slum cluster of Dhaka, Bangladesh, during March-April 2008 using the Proportion Probability to Size method. Participants were interviewed, with a response rate of 99.2% (n = 595), using a structured questionnaire and asked about illicit substance use, sexual behaviour and risk perception for HIV and sexually transmitted diseases. Independent predictors of having sex with FSWs were analysed by multivariate analysis. A qualitative study was subsequently conducted with 30 rickshaw pullers to supplement the findings of the initial survey. RESULTS: The proportion of survey respondents who had sex with FSWs and those who used illicit substances in the previous 12 months period were 7.9% and 24.9%, respectively, much lower than the results achieved in the 2003-04 behavioural surveillance (72.8% and 89.9%, respectively). Multivariate analysis revealed the characteristics of younger age, being never married, living alone with family remaining in other districts and using illicit substances in the previous 12 months were significantly associated with having sex with FSWs. CONCLUSION: HIV-related risk behaviour of our study population of the rickshaw pullers was lower than what has been suggested by the results of behavioural surveillance. While this discrepancy should be addressed in further studies, our study emphasizes the importance of focused HIV prevention programs for rickshaw pullers as high-risk behaviour is displayed at an unacceptable level and concentrated in identifiable sub-populations.

Behavioral and psychosocial predictors of condom use among university students in Eastern China.

In China the HIV epidemic has started to infiltrate into a broader population through heterosexual contact and particularly to impact young people. The purpose of this study was to identify behavioral and psychosocial correlates of condom use among Chinese university students. A self-administered questionnaire survey with cross-sectional design was conducted among all classes of undergraduate students at two universities in one municipality of Eastern China, 2003. Data obtained from 1850 sexually active students who answered the question on condom use during the previous year were used for analysis. Frequent (always/often) condom use during the previous year was reported by only about 40% of both men and women. Multivariate analysis revealed that condom use during the first sexual experience, oral contraceptive use in the previous year and higher condom self-efficacy score in both genders were potent predictors of frequent condom use, while frequent condom use was less likely practiced by men who ever had non-vaginal sex, by those with higher risk-awareness for pregnancy/HIV/sexually transmitted diseases and by women with lower scores for perceived condom benefits. Safe sex education for Chinese students should be urgently introduced and should not be limited to knowledge provision but should also address psychosocial factors, such as condom self-efficacy and gender differences adequately to effectively encourage safer behavior.

Unintended pregnancy and its risk factors among university students in eastern China.

BACKGROUND: The study was conducted to determine the prevalence of unintended pregnancy, induced abortion and contraceptive use, and factors associated with unintended pregnancy among Chinese university students. STUDY DESIGN: A self-administered questionnaire survey with cross-sectional design was administered among students in two universities in Ningbo, China, in November-December 2003. Sociodemographic and behavioral factors associated with unintended pregnancy were identified in both genders using univariate and multivariate analyses. RESULTS: Of sexually active students, 10.6% of male and 11.6% of female students reported their partner or they had a history of pregnancy; 10.0% of male and 11.3% of female students reported their partner or they had a history of induced abortion. The risk factors for unintended pregnancy identified among males by multivariate analysis were older age [odds ratio (OR), 2.12; 95% confidence interval (CI), 1.15-3.88], initiation of sexual activity before high school (OR, 2.45; 95% CI, 1.36-4.44), reported lack of condom use in first sexual activity (OR, 1.71; 95% CI, 1.10-2.64), multiple sexual partners (OR, 1.54; 95% CI, 1.06-2.23), and often used condoms during their lifetime (OR, 1.97; 95% CI, 1.01-3.81). The identified risk factors among females were initiation of sexual activity before high school (OR, 5.12; 95% CI, 1.49-17.68), non-consensual sexual intercourse as first sex (OR, 1.77; 95% CI, 1.08-2.90), multiple partners (OR, 2.75; 95% CI, 1.61-4.71), and sometimes/never (OR, 3.02; 95% CI, 1.16-7.87) or often (OR, 3.92; 95% CI, 1.43-10.73) used condoms during their lifetime. CONCLUSION: The high prevalence of unintended pregnancies and induced abortions in this population indicates a need for better and targeted sex education and family planning services.

Prevalence and correlates of hepatitis C virus infection among injecting drug users in Tehran.

This study aimed to investigate the prevalence and correlates of hepatitis C virus infection among injecting drug users in a community-based setting in Tehran, Iran. In October 2004, injecting drug users were recruited from a drop-in centre and neighboring parks and streets in a drug-populated neighborhood in Tehran. Participants were interviewed using a structured questionnaire, and a sample of oral mucosal transudate was collected for detection of HIV and HCV antibodies. Overall, 105 of 202 participants (52.0%) were found to be positive for HCV-antibody testing. After adjustment for the basic demographic characteristics, the prevalence of HCV infection was found to be associated with length of drug injection (more than 10 years) [odds ratio (OR), 3.25; 95% confidence interval (CI), 1.43-7.38], length of lifetime incarcerations (more than a year) (OR, 3.44; 95% CI, 1.68-7.06), and a history of being tattooed inside prison (OR, 1.96; 95% CI, 1.06-3.62). High prevalence of HCV infection and its association with incarceration-related exposures are important implications for harm reduction initiatives for drug using inmates in Iran. While prevention interventions for drug using inmates are being expanded in Iran, it is important that high prevalence of HCV infection be taken into consideration in order to control further transmission of this infection.

Sexual behavior and awareness of Chinese university students in transition with implied risk of sexually transmitted diseases and HIV infection: a cross-sectional study.

BACKGROUND: The vulnerability of young people to HIV and the recent emergence of the HIV epidemic in China have made it urgent to assess and update the HIV/STD risk profile of Chinese young people. METHODS: A self-administered questionnaire survey with cross-sectional design was conducted among 22,493 undergraduate students in two universities in Ningbo, China. Bivariate trend analysis and multiple logistic regression analysis were used to compare sexual behaviors and awareness between grades. RESULTS: Of respondents, 17.6% of males and 8.6% of females reported being sexually active. Condom was reported never/rarely used by 35% of sexually active students in both genders in the previous year. Pregnancy and induced abortion had each been experienced by about 10% of sexually active female students and the female partners of male students, and about 1.5% of sexually active students of both genders reported being diagnosed with an STD. Multivariate analysis revealed that students in lower grades, compared to those in higher grades, were more likely to have become sexually active before university, to have become aware of sex before high school, and to have been exposed to pornographic media before the age of 17 years, and for sexually active respondents of both genders, to have engaged in sex without using a condom. CONCLUSION: Sexual behaviors of Chinese university students are poorly protected and sexual behaviors and awareness may have been undergoing rapid change, becoming active earlier and more risky. If this trend continues, vulnerable sexual network will grow among them that allow more expansion of sexually transmitted diseases and HIV.

High prevalence of HIV infection associated with incarceration among community-based injecting drug users in Tehran, Iran.

OBJECTIVES: To determine the prevalence and correlates of HIV-1 infection among community-based injecting drug users (IDUs) in Tehran, Iran. METHODS: In October 2004, 213 IDUs were recruited from a drop-in center and its neighboring parks and streets in Tehran. Participants were interviewed using a structured questionnaire regarding their sociodemographics and HIV risk characteristics, and specimens of oral mucosal transudate were collected and tested for HIV-1 antibodies. Data were analyzed using chi and multiple logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI). RESULTS: The prevalence of HIV-1 infection was 23.2% (48 of 207) among male injecting drug users. In the multivariable analysis, a history of shared drug injection inside prison (OR, 2.45; 95% CI, 1.01-5.97) and that of multiple incarcerations (OR, 3.13; 95% CI, 1.08-9.09) were associated with significantly higher prevalence of HIV-1 infection. CONCLUSIONS: The prevalence of HIV-1 infection has reached an alarming level among IDUs in Tehran, with incarceration-related exposures revealed to be the main correlates of HIV-1 infection. Urgent and comprehensive harm reduction programs for drug users in prison and those in the community in Tehran are of prime importance to prevent further transmission of HIV infection.

Needle and syringe sharing practices of injecting drug users participating in an outreach HIV prevention program in Tehran, Iran: a cross-sectional study.

HIV infection rates have reached epidemic proportions amongst injecting drug users (IDUs) in Iran. Although a number of community-based interventions have being implemented in the country, there is little information on the risk behaviors of IDU participants in these programs. This cross-sectional report aimed to compare the risk behaviors of injecting drug users with differential exposure rates to an HIV outreach program in Tehran, Iran. Results indicated that shared use of needle/syringe in the past month was significantly lower among IDUs who received estimated > or = 7 syringes per week than those who did not [adjusted odds ratio (OR) = 14.36, 95% confidence interval (CI) 2.30-89.56]. While the effectiveness of this outreach program needs further evaluation through a longitudinal investigation, our preliminary findings suggest that the outreach program in Tehran may have been beneficial in reducing direct sharing among those who received more than several needles/syringes from the program.