Your Clothes Aren't Going to Magically Come Off": An Exploratory Study of U.S. Latino Adolescents' Reasons for Having or Not Having First-Time Vaginal Intercourse / "Su ropa no se quita mágicamente": Estudio exploratorio sobre las razones para tener o no tener coito vaginal por primera vez en adolescentes estadounidenses-latinos

US Latino adolescents have higher teenage birthrates and higher probabilities for early sexual initiation, compared to other racial/ethnic groups. Understanding their reasons for delaying or initiating first-time vaginal intercourse is important in designing culturally relevant health promotion programs. Using qualitative methods, we analyzed 21 semi-structured interviews with US Latino adolescents regarding their sexual initiations. Seven had sexually debuted, acknowledging sexual feelings of desire, curiosity and pleasure for their romantic partner. The remaining 14 had not debuted citing reasons of self-interest and external prohibitive factors. Eight out of 14 also attributed their status to not being in a romantic relationship. Our findings suggest several areas for increased discussion including how romantic relationships and Latino cultural values influence sexual initiation and the use of contraception. These findings could improve health promotion programs by identifying critical elements that may resonate with US Latino adolescent socio-cultural values and sexual development.

Los adolescentes latinos de Estados Unidos presentan tasas de natalidad más altas y mayores probabilidades de iniciación sexual temprana en comparación con adolescentes de otros grupos raciales-étnicos. Entender las razones de los jóvenes latinos para retrasar o iniciar el coito vaginal por primera vez es importante en el diseño de programas de promoción de salud culturalmente relevantes. En el presente estudio cualitativo se realizaron 21 entrevistas semiestructuradas con adolescentes latinos sobre las razones para iniciarse o abstenerse de practicar el coito vaginal por primera vez. Siete de los participantes habían debutado sexualmente y 14 se habían abstenido de hacerlo. Quienes se habían iniciado reconocieron haberlo hecho por curiosidad, deseo sexual y por placer, pero admitieron haberse iniciado sexualmente en el contexto de una relación romántica con su pareja. Quienes se habían abstenido reportaron razones personales (no sentirse preparados, esperar hasta el matrimonio, temor de adquirir una infección sexualmente transmisible o de quedar embarazada) y también citaron fuentes externas de prohibición (padres y religión). Ocho de los 14 adolescentes también atribuyeron el haberse abstenido al no haber establecido una relación romántica todavía. El análisis de los resultados sugiere que los adolescentes latinos de los Estados Unidos con características similares a la muestra estudiada tienen los conocimientos y están dispuestos a tomar decisiones razonadas sobre su iniciación sexual.

HIV/AIDS treatment adherence in economically better off women in Colombia.

Studies on HIV/AIDS treatment adherence have been carried out in a limited number of geographic settings, but few studies have explored it in people of higher socioeconomic status in Latin America. This qualitative study explored and compared determinants of adherence behaviors among 52 HIV-positive Colombian women in medium and high socioeconomic positions (SPs). Findings indicated that the two SP groups reported high adherence behaviors related to taking medication, following a diet, and executing lifestyle changes in line with healthcare providers' recommendations. Nevertheless, differences were observed between the two groups. While women with a medium SP disclosed their diagnosis, were empowered, and had acceptable access to economic resources that resulted in favorable adherence, their better off counterparts tended to hide their status and made a conscious effort to keep their adherence behaviors in secret due to HIV-related stigma. More studies on adherence of people living with HIV/AIDS from high SPs should be conducted to better understand how psychosocial support can be provided and to advance the knowledge of how and why adherence practices in these groups are undertaken.

Applying an expanded social determinant approach to the concept of adherence to treatment: the case of Colombian women living with HIV/AIDS.

BACKGROUND: The purpose of this study was to explore and analyze social determinants that influence adherence among Colombian women living with HIV/AIDS in poverty conditions. METHODS: A qualitative, descriptive-interpretative study was developed. Forty-seven women participated in five focus group discussions. Also, in-depth interviews with six women were conducted. FINDINGS: Results showed that women with lower adherence sell their antiretroviral medication to satisfy economic needs, and prioritize the care of their HIV-positive children over their own adherence needs. In contrast, women with higher adherence were found to participate in social support groups offered by nongovernmental organizations. CONCLUSION: These findings underscore the need to understand the social determinants that facilitate and/or hinder adherence among women in poverty-associated conditions. Results indicate the need to facilitate access to treatment on a timely and continual basis; provide economic resources, including support to meet basic needs as well as subsidies for transportation to health care centers; and explore mechanism for supporting the care of their offspring.

HPV knowledge, attitudes, and cultural beliefs among Hispanic men and women living on the Texas-Mexico border.

BACKGROUND: US Hispanic women have higher cervical cancer incidence rates than non-Hispanic White and African-American women and lower rates of cervical cancer screening. Knowledge, attitudes, and cultural beliefs may play a role in higher rates of infection of human papillomavirus (HPV) and decisions about subsequent diagnosis and treatment of cervical cancer. STUDY AIM: To explore the level of HPV knowledge, attitudes, and cultural beliefs among Hispanic men and women on the Texas-Mexico border. METHODOLOGICAL APPROACH: Informed by feminist ethnography, the authors used an interpretive approach to understand local respondents' concerns and interests. Focus group sessions were analyzed using thematic content analysis. RECRUITMENT AND SAMPLE: Promotoras (lay health workers) recruited participants using convenience sampling methods. Group sessions were held in public service centers in Brownsville. Participants' ages ranged from 19 to 76 years. METHODS ANALYSIS: Focus group discussions were audio-recorded and transcribed in Spanish. Researchers read and discussed all the transcripts and generated a coding list. Transcripts were coded using ATLAS.ti 5.0. KEY FINDINGS: Participants had little understanding about HPV and its role in the etiology of cervical cancer. Attitudes and concerns differed by gender. Women interpreted a diagnosis of HPV as a diagnosis of cancer and expressed fatalistic beliefs about its treatment. Men initially interpreted a diagnosis of HPV as an indication of their partners' infidelity, but after reflecting upon the ambiguity of HPV transmission, attributed their initial reaction to cultural ideals of machismo. Men ultimately were interested in helping their partners seek care in the event of a positive diagnosis. IMPLICATIONS FOR PRACTICE: Results suggest that understanding Hispanics' cultural norms and values concerning disease, sexuality, and gender is essential to the design and implementation of interventions to prevent and treat HPV and cervical cancer.

Social position, gender role, and treatment adherence among Colombian women living with HIV/AIDS: social determinants of health approach / Posición social, papel de género y adhesión al tratamiento en mujeres colombianas con VIH/sida: enfoque de los determinantes sociales de la salud

OBJECTIVE: To assess and analyze the associations between adherence to treatment and social position in women living with HIV/AIDS. METHOD: A cross-sectional, descriptive, correlational study among 269 Colombian women was conducted. Participants completed three questionnaires: a socio-demographic and clinical characteristics survey, a treatment adherence scale, and a social position survey. RESULTS: Women of low social position had a significantly higher probability of low treatment adherence (OR = 5.651, P < 0.0001), and the majority of social position variables measured had a significant effect on adherence. A general model considering the variables "type of national health care plan" ("contributive," "subsidized," or, in the case of vinculadas or the uninsured, "none"); "having HIV-positive children"; and "level of viral load" was statistically reliable in predicting study participants' treatment adherence. Membership in the subsidized plan or being uninsured had a greater effect on the probability of low adherence than membership in the contributive plan (OR = 3.478, P < 0.0001). Univariate regression analyses confirmed that women with HIV-positive children and a viral load > 400 copies/ml were more likely to have low adherence than women without those characteristics (OR = 2.395, P = 0.0274 and OR = 2.178, P = 0.0050, respectively). CONCLUSIONS: Improving women's adherence to HIV/AIDS treatment in Colombia would require eliminating barriers to national health care system and comprehensive health care services and implementing programs that take into account women's role as maternal caregivers The findings underscore the need to integrate variables related to gender inequality and social position in treatment adherence analysis, as advocated in the social determinants of health approach.

OBJETIVO: Evaluar y analizar las asociaciones existentes entre la adhesión al tratamiento y la posición social de las mujeres con VIH/sida. MÉTODOS: Se realizó un estudio transversal, descriptivo y correlacional con 269 colombianas. Las participantes respondieron tres cuestionarios: uno sobre las características sociodemográficas y clínicas, uno sobre su posición social y una escala sobre la adhesión al tratamiento. RESULTADOS: Las mujeres de baja posición social tenían una mayor probabilidad de presentar baja adhesión al tratamiento (OR = 5,651; P < 0,0001); la mayoría de las variables de posición social influyeron significativamente sobre la adhesión. Un modelo general con las variables "tipo de plan nacional de salud" ("contributivo", "subsidiado" o, en las vinculadas y las no aseguradas, "ninguno"), "tener hijos positivos al VIH" y "nivel de carga viral" resultó estadísticamente fiable para predecir la adhesión al tratamiento. Ser miembro del plan subsidiado o no tener seguro influyeron más en la probabilidad de baja adhesión al tratamiento que ser miembro del plan contributivo (OR = 3,478; P < 0,0001). El análisis de regresión monofactorial confirmó que las mujeres con hijos positivos al VIH o carga viral > 400 copias/mL tenían mayor probabilidad de presentar baja adhesión que las mujeres sin esas características (OR = 2,395; P = 0,0274 y OR = 2,178; P = 0,005, respectivamente). CONCLUSIONES: Mejorar la adhesión de las mujeres al tratamiento para el VIH/sida en Colombia requiere eliminar barreras al sistema nacional de salud, brindar servicios integrales e implementar programas que tomen en cuenta el papel de las mujeres como madres cuidadoras de enfermos. Estos resultados subrayan la necesidad de integrar variables relacionadas con la inequidad de género y la posición social al análisis de la adhesión al tratamiento, como promueve el enfoque de determinantes sociales de la salud.

Sexuality during the climacteric period.

BACKGROUND: Cultural, social, physiological and psychological factors may alter the course of sexual function in climacteric women. OBJECTIVE: The objective of the present literature review is to survey the prevalence of sexual dysfunctions in the climacteric and to establish the association between the organic and psychic changes that occur during this phase and sexual dysfunction. We also discuss potential treatments. METHODS: We evaluated the data available in PubMed (1982-2008). For each original article, two reviewers analyzed the data independently and considered a study to be of high quality if it had all three of the following characteristics: prospective design, valid data and adequate sample size. Both reviewers extracted data from each of the 99 studies selected: 34 cross-sectional studies, 25 cohort studies, 9 trials, 31 reviews related to sexuality in pre- and post-menopausal women. RESULTS: Sexual dysfunction among climacteric women is widespread and is associated with bio-psychosocial factors. However, there is not enough evidence to correlate sexual dysfunction with a decrease in estrogen levels and biological aging. A strong association exists between climacteric genital symptoms and coital pain. There is, however, sufficient evidence demonstrating the benefits of local estrogen therapy for patients with genital symptoms. CONCLUSION: A significant decline in sexual function occurs in climacteric women, although it is still unclear whether this is associated with the known decrease in estrogen levels or with aging, or both. Relational factors may interfere with sexual function during this phase. The climacteric genital symptoms improve with estrogen replacement therapy, and positively influence sexual function. Further studies are needed to establish the actual impact of the decrease in estrogen levels and of aging on the sex life of climacteric women.

The effects of hypoestrogenism on the vaginal wall: interference with the normal sexual response.

INTRODUCTION: The sexual response depends on the adequate function of all systems related to the genital and extra-genital organs. Physiological conditions such as menopause can interfere with sexual expression because of central and peripheral changes. Genital effects of estrogen include vaginal trophism, lubrication, and local pleasure sensation in the sexual arousal phase. Hypoestrogenism causes changes in the four layers of the vaginal wall that may result in dyspareunia and a loss in the quality of the genital arousal response. AIM: The purpose of this review is to highlight the changes in the vaginal wall caused by hypoestrogenism, its possible relationship with dyspareunia, and its repercussions for genital arousal. Treatments for hypoestrogenism are also discussed. METHODS: We evaluated the data available in PubMed (1982-2008) and surveyed the reference list for relevant studies. Two reviewers analyzed the data independently. A study was considered to be of high quality if it had all three of the following characteristics: (i) prospective design; (ii) valid data; and (iii) adequate sample size. Reviews and experimental animal studies were also considered. MAIN OUTCOME MEASURES: Normal genital morphology, hypoestrogenism and hormone replacement therapy were the focus of the studies reviewed in this paper. RESULTS: Atrophy of the vaginal wall may be associated with dyspareunia and genital sexual arousal disorder, but psychological and sociocultural aspects must also be considered. Regardless, however, local estrogen therapy is useful in improving vaginal wall trophism and, thus, in improving the sexual response. CONCLUSIONS: There are many possible alterations in the structure of the vaginal wall that are related to estrogen deficiency that may require medical intervention beyond the usual strategies used to attain adequate sexual function. Physicians should attempt to treat these alterations, and more research is needed to elucidate the physiopathology of dyspareunia and genital sexual arousal physiology.

Social position, gender role, and treatment adherence among Colombian women living with HIV/AIDS: social determinants of health approach.

OBJECTIVE: To assess and analyze the associations between adherence to treatment and social position in women living with HIV/AIDS. METHOD: A cross-sectional, descriptive, correlational study among 269 Colombian women was conducted. Participants completed three questionnaires: a socio-demographic and clinical characteristics survey, a treatment adherence scale, and a social position survey. RESULTS: Women of low social position had a significantly higher probability of low treatment adherence (OR = 5.651, P < 0.0001), and the majority of social position variables measured had a significant effect on adherence. A general model considering the variables 'type of national health care plan' ('contributive,' 'subsidized,' or, in the case of vinculadas or the uninsured, 'none'); 'having HIV-positive children'; and 'level of viral load' was statistically reliable in predicting study participants' treatment adherence. Membership in the subsidized plan or being uninsured had a greater effect on the probability of low adherence than membership in the contributive plan (OR = 3.478, P < 0.0001). Univariate regression analyses confirmed that women with HIV-positive children and a viral load > 400 copies/ml were more likely to have low adherence than women without those characteristics (OR = 2.395, P = 0.0274 and OR = 2.178, P = 0.0050, respectively). CONCLUSIONS: Improving women's adherence to HIV/AIDS treatment in Colombia would require eliminating barriers to national health care system and comprehensive health care services and implementing programs that take into account women's role as maternal caregivers The findings underscore the need to integrate variables related to gender inequality and social position in treatment adherence analysis, as advocated in the social determinants of health approach.

Condom use self-efficacy among U.S. and foreign-born Latinos in Texas.

The objective of this study was to assess the influence of condom use self-efficacy on the reported condom use of Latinos. We conducted a rapid needs assessment study among U.S. and foreign-born Latinos living in Houston, TX, to identify behavioral and psychosocial factors that influence their risk for HIV. Bilingual Latino interviewers conducted confidential face-to-face interviews with individuals living in apartment complexes or residential areas primarily populated by Latinos. A total of 152 participants completed the survey. Regression results indicate that education and gender influenced condom use self-efficacy, which in turn influenced condom use in the last sexual encounter and with the primary sexual partner. However, gender and relationship risk were stronger predictors of condom use. Study results indicate that there are differences in condom use self-efficacy and sexual risk behaviors between Latino men and women that need further exploration.

El examen sexologico en las disfunciones excitatorias y orgásmicas femeninas

Con base los trabajos de Zwing, Hoch y Heli Alzate sobre erogenicidad vaginal se plantea la importancia del examen sexolpgico, en particular, cuando la paciente consulta por disfunción orgásmica coital. Se decribe brevemente el protocolo del examen propuesto por los autores mencionados y se ubica en el contexto de la valoración general de la función erótica femenina. Por ser relevancia, se discuten los aspectos éticos pertinentes.Las principales conclusiones son:1. En la gran mayoría de las mujeres existen una excitación sexual suficiente para alcanzar con facilidad el orgasmo. 2. El coito vaginal es una actividad poco eficaz para producir el orgasmo femenino.3. Una evolución pretratamiento de las disfunciones orgásmicas coitales debería incluir la localización de las zonas erógenas en la vagina.4. A la luz de estos estudios deberán revisarse las teorías sobre las causas de las disfunciones orgásmicas en ola mujer y modificarse los métodos sexoterapeúticos. 5. Es responsabilidad de los (as)especialistas en ginecologia el contribuir a la salud sexual, tanto reproductiva como erótica, de nuestra población(AU)