Relación de la educación, conocimiento y percepción de la satisfacción sexual de los estudiantes heterosexuales cis-género de la Universidad Andrés Bello sede Viña del Mar (Chile), año 2022 / Relationship of education, knowledge and perception of sexual satisfaction of cis-gender heterosexual students at Universidad Andrés Bello Viña del Mar (Chile) headquarters, year 2022

INTRODUCCIÓN: Los humanos son seres sexuados, gran parte de ellos mantienen una vida sexual activa y comienzan a una edad temprana; sin embargo, esto puede llegar a ser un problema si no se cuenta con una base óptima de educación sexual, ya que ésta fomenta el autoconocimiento de cada persona, permitiendo una vida sexual plena. OBJETIVO: Relacionar la educación sexual con la percepción de la satisfacción sexual y el conocimiento de los genitales externos del sexo opuesto en mujeres y hombres heterosexuales cis-género. MATERIALES Y MÉTODOS: Estudio cuantitativo observacional analítico transversal, mediante la clasificación de preguntas y respuestas estructuradas, cuantificables realizada a estudiantes cis heterosexuales entre 18 y 25 años. RESULTADOS: Los resultados de esta investigación demostraron las diversas edades de inicio de actividad sexual, cantidad de parejas sexuales y la percepción de la vida sexual actual de los encuestados, reflejando que la mayoría de los mismos comenzaron su vida sexual tempranamente y, sin embargo, mantenían una baja cantidad de parejas sexuales. Aun con estos condicionantes, los sujetos refieren mantener una buena satisfacción sexual, queriendo conservar su vida sexual actual. CONCLUSIONES: Aún se aprecia la brecha de conocimientos desde los distintos niveles de educación, asimismo, se puede evidenciar la poca investigación en relación con la satisfacción sexual que existe en Chile. Por otra parte, la importancia que posee el/la profesional matrón/a es fundamental en cada una de las variables estudiadas ya que, es el profesional más capacitado para abordar este ámbito.

INTRODUCTION: Humans are sexed beings, which many of them maintain an active sexual life and begin at an early age however, this could be a problem if there is not an optimal base of sexual education. OBJECTIVE: To relate sexual education with the perception of sexual satisfaction and knowledge of the external genitalia of the opposite sex in cis-gender heterosexual women and men. MATERIALS AND METHODS: Cross-sectional analytical observational quantitative study, through the classification of structured questions and answers, quantifiable carried out to cis heterosexual students between 18 and 25 years. RESULTS: The results of this research, demonstrated the different ages of initiation of sexual activity, number of sexual partners and the perception of the current sexual life of the respondents, reflecting that most of the respondents began their sexual life early, however they maintained a low number of sexual partners, even so these refer to maintain a good sexual satisfaction wanting to maintain their current sexual life. CONCLUSIONS: The knowledge gap between the different levels of education is still evident, as well as the lack of research on sexual satisfaction in Chile. On the other hand, the importance of the professional midwife is fundamental in each of the variables studied, since he/she is the most qualified professional to address this area.

Comportamentos sexuais durante a pandemia da Covid-19: representações sociais de homens gays e heterossexuais

Objetivo. O presente artigo objetivou comparar as representações sociais (RS) entre grupos de homens gays e heterossexuais sobre os comportamentos sexuais face ao isolamento social decorrente da pandemia da Covid-19. Método. Participaram 200 homens (100 heterossexuais e 100 homossexuais), com médias de idade de 27,06 e 28,12, respectivamente. Utilizou-se um formulário sociodemográfico on-line e uma entrevista semiestruturada com duas perguntas disparadoras para apreensão das RS. Os dados foram analisados pelo software IRAMUTEQ. Resultados. Verificou-se similaridades em ambos os grupos quanto a vida sexual ativa e uso de tecnologias para Sexting e acesso a pornografia. Entretanto, os homossexuais divergem na estrutura representacional ao buscarem estas estratégias compensatórias em maior quantidade, em razão de relacionamentos com pouca duração e/ou pouca união estável. Conclui-se que o distanciamento físico desvela intercorrências heterogêneas à vida afetivo-sexual nessa nova realidade social.

Objective. This article aimed to compare the social representations between groups of gay and heterosexual men about sexual behavior as a result of social isolation from the Covid-19 pandemic. Method. 200 men participated (100 heterosexuals and 100 homosexuals) with average age of 27.06 and 28.12, respectively. A sociodemographic questionnaire was used for sample characterization and a semi-structured interview for the apprehension of SR, with data processed by the IRAMUTEQ software. Results. Similarities were found in both groups in terms of active sex life and the use of technologies for sexing and access to pornography. However, homosexuals diverge in the representational structure when seeking greater compensatory strategies for having more stable civic states. It is concluded that physical distance reveals heterogeneous intercurrences to affective-sexual life in this new social reality.

Internet Study about Risk Factors Associated with HIV among Heterosexuals in Puerto Rico.

OBJECTIVE: Heterosexual intercourse is the main mode of HIV transmission among heterosexual women in Puerto Rico and the third for men. We conducted an Internetbased study of heterosexual young adults in Puerto Rico to explore their sexual practices, beliefs and decision-making skills for HIV prevention. Data presented in this study will help to understand the factors that contribute to the sexual transmission of HIV among heterosexuals within the Puerto Rican context. METHODS: We administered an online-based survey to a sample of 618 young adult heterosexual men and women. Data were collected using Perseus Survey Solutions software. RESULTS: Overall, most participants expressed they had the same sexual partner in the previous six months, never or almost never used male condoms with their main partner and did not perceive themselves at-risk of contracting HIV (have a low HIV risk perception). Men reported using male condoms more frequently than women (e.g. male condom on their male partner) during vaginal sex, in particular single and younger men. Women expressed more positive attitudes toward male condoms than men. CONCLUSION: Results confirm the need to implement interventions that increases the sense of vulnerability among heterosexuals, as well as skills and use of male condoms. This study contributes additional data on sexual practices and attitudes to encourage the identification of new or current changes in HIV protective or risk factors, specifically for an understudied population of Heterosexuals in Puerto Rico.

Modeling HIV prevention strategies among two Puerto Rican samples / Modelacion de estrategias para la prevención del VIH en dos muestras puertorriqueñas

The Information-Motivation-Behavioral Skills model examines factors that are used to initiate and maintain sexual and reproductive health promotion behaviors. The present study evaluated the association among these constructs as it is applied to sexually active heterosexual adults with steady partners, using a Structural Equation Modeling approach. At the same time, it was analyzed if the same model structure could be generalized to two samples of participants that produced the results following two different formats for data collection. Two-hundred ninety one participants completed the Information-Motivation- Behavioral Skills Questionnaire (Spanish version), and 756 participants completed an Internet version on the instrument. The proposed model fits the data for both groups, supporting a predictive and positive relationship among all of the latent variables, with Information predicting Motivation, and Motivation therefore predicting Behavioral Skills. The findings support the notion that there are important issues that need to be addressed when promoting HIV prevention.(AU)

El modelo de Información-Motivación-Destrezas (IMB) evalúa factores que facilitan la promoción de practicas sexuales de menor riesgo. El presente estudio examinó la aplicación de este modelo en una muestra puertorriqueña utilizando la modelación de ecuaciones estructurales con adultos heterosexuales con al menos una pareja estable. A la vez, evaluamos si el modelo podía ser aplicado a más de una muestra. La primera muestra (N= 291) completó la versión en papel y lápiz de el instrumento, mientras la segunda muestra (N= 756) completó la versión electrónica del mismo. Los resultados reflejan que existe una asociación de predicción entre los componentes del modelo IMB, donde el tener información sobre el VIH/SIDA predijo el nivel de motivación para tener sexo más seguro, y este factor a la vez predijo el nivel de autoeficacia para la negociación sexual (destrezas). Estos resultados apuntan la necesidad de identificar múltiples factores que facilitan las prácticas sexuales de menor riesgo.(AU)

Risk factors for concordant HIV infection in heterosexual couples in Trinidad.

Risk factors for HIV infection in partners of HIV-seropositive index cases were investigated in a cross-sectional survey. Between September 1992 and April 1994 a total of 251 HIV-infected persons and 76 of their sexual partners were interviewed at the main sexually transmitted diseases (STDs) clinic in Trinidad. All participants gave signed consent and responded to a questionnaire. Sixty-four couples had risks for HIV infection through heterosexual intercourse only. However, many recruited sex partners (57/64) reported heterosexual intercourse with persons in addition to the index cases. Overall HIV concordance (both index case and partner HIV infected) was 45% in the couples. HIV concordance was not found to be related to the sexual practices within the studied unions nor to the clinical status of the index case. After allowing for confounding factors there was an increased risk for HIV concordance in couples in unions for > or = 1 year (adjusted OR 3.48; 95% CI 0.89-13.69, P = 0.055), and in those in which sex partners had a past history of genital sores (adjusted for prostitution: OR 4.50; 95% CI 1.01-20.4). Interventions targeted at reducing high-risk sexual behaviour, prostitution and cocaine use could be beneficial in reducing the spread of STDs and HIV in Trinidad.

PIP: A cross-sectional survey conducted at the main sexually transmitted disease clinic in Trinidad in 1992-94 investigated risk factors for concordant HIV infection in 251 HIV-infected persons and 76 of their sexual partners. Sexual contact with the index case was the only reported HIV risk factor for 7 partners; another 57 partners with heterosexual intercourse as the sole HIV risk factor reported intercourse with persons in addition to the index case in the preceding 5 years. Overall, HIV concordance was 45% (38% in couples with a female index case and 50% when the index case was male). HIV concordance was unrelated to either sexual practices within the studied unions (e.g., frequency of intercourse, condom use, male circumcision, sex during menstruation) or the current clinical status of the index case. After adjustment for confounding factors, there was an increased risk for HIV concordance among couples in unions for 1 or more years (adjusted odds ratio (OR), 3.48; 95% confidence interval (CI), 0.89-13.69) and those in which sex partners had a past history of genital sores (OR adjusted for prostitution, 4.50; 95% CI, 1.01-20.4). These findings suggest a need for policies to ensure that the sex partners of HIV-infected persons in Trinidad are notified, counseled, and offered HIV testing because of their elevated risk of infection.

Influence of HIV positive status on sexual behavior among males.

OBJECTIVE: To compare HIV seronegative (HIV-) and HIV seropositive (HIV+) males in terms of sexual behavior with female and male partners of different types. METHOD: Cross-sectional study. From August 1994 to February 1995, a sample of 236 respondents (150 HIV- and 86 HIV+) recruited from public health centers in the State of S. Paulo (Brazil), answered a questionnaire, including questions on demographic aspects, HIV and AIDS related knowledge, sexual orientation, use of alcohol and other drugs, sexual behavior with regular and casual female and male partners, and perceived risk of HIV infection. Sexual behavior with regular and casual female and male partners within the previous three months, was investigated. RESULTS: A lower proportion of HIV+ engaged in sexual contact with regular female partners (p < .01) and in vaginal intercourse with this type of partner (p < .01). A lower proportion of HIV+ engaged in overall sexual activity (p < .001) and reported lower frequency of penetrative sexual practices (p < .05). A high level of condom use with female and male partners was identified with no significant differences being found between the two serostatus groups. Some risky sexual behavior was identified, however, especially with regular partners, suggesting that some men were continuing to practice unsafe sex. CONCLUSIONS: The high level of condom use identified suggests that safer sex advice has been taken up. Condom use was not universal, however, and some men continue to place themselves at risk, especially with regular partners. Prevention programs should strive not only to encourage HIV- to practice safer sex, but also to encourage HIV+ to do so in order to prevent further transmission of the virus.

PIP: Findings are presented from a cross-sectional study comparing the sexual behavior of HIV-seronegative and HIV-seropositive men with male and female sex partners, with particular focus upon the practice of safer sex in both groups of men. The 150 HIV-seronegative and 86 HIV-seropositive participating males were recruited between August 1994 and February 1995 from public health centers in the state of Sao Paulo, Brazil, where they responded to a questionnaire. The men were 15-69 years old, of mean age 30 years. 78% were single, 14.4% were married/living together, 6.4% were separated/divorced, and 1.3% were widowers. 36% defined themselves as heterosexuals, 11.4% as bisexuals, and 36.4% as homosexuals, while 16.1% used other expressions. Compared to HIV-seronegative men, a smaller proportion of HIV-seropositive men had sexual contact with regular female partners and engaged in vaginal intercourse with that type of partner. Similarly, a smaller proportion of HIV-seropositive men engaged in overall sexual activity and reported a lower frequency of penetrative sexual practices. A high level of condom use with male and female sex partners was identified with no significant differences being found between the 2 serostatus groups. However, some risky sexual behavior was identified, especially with regular partners, suggesting that some men were continuing to have unsafe sex. HIV prevention programs should encourage both HIV-seronegative and HIV-seropositive men to practice safer sex.

Herpes simplex virus type 2 in Brazil: seroepidemiologic survey.

BACKGROUND: The incidence of genital herpes is increasing worldwide. Herpes simplex virus type 2 (HSV-2) is the most common cause of genital ulcerations among the sexually transmitted diseases (STDS). In order to investigate the sexual transmission of genital herpes infection in Brazil, the prevalence of specific antibodies to HSV-2, in populations of high and low risk for STDS was evaluated. METHODS: The population at low risk for STDS was composed of 155 voluntary blood donors at the University Hospitals between February and August, 1994. The population at high risk for STDS was composed of 85 HIV-seropositive persons, consisting of homosexual and promiscuous heterosexual men. A group of 20 highly active prostitutes was also studied between May and July, 1994. All blood samples were screened using an enzyme-linked immunosorbent assay (ELISA) that detects type-specific antibodies to HSV-2 glycoprotein G. Before donating blood, all persons in the study group were given a questionnaire concerning risk factors for acquisition of STDS and suitable to show the socioepidemiologic characteristics of the subjects. RESULTS: The prevalence of ELISA showing HSV-2 infections among HIV-seroposite persons, was 73% (P < 0.01). In the whole group at high risk for STDS, the prevalence was 72% (P < 0.05). Infection with HSV-2, as determined by seroprevalence, was significantly and independently associated with years of sexual activity, history of previous STDS, number of sexual partners in the previous month, number of pregnancies, and previous induced abortions, as well as the percentage of sexual acts involving receptive anal intercourse. CONCLUSIONS: The current strategy for diagnosing genital HSV-2 infection misses many cases. Newly developed type-specific serologic methods can identify cases of unrecognized or subclinical infection. With the high seroprevalence rates detected, routine screening for HSV-2-specific antibodies should be considered in populations at high risk for STDS.

PIP: The incidence of genital herpes is increasing worldwide and herpes simplex virus type 2 (HSV-2) is the most common cause of genital ulcerations among sexually transmitted diseases (STDs). Findings are reported from an assessment of the prevalence of antibodies to HSV-2 in low- and high-risk populations in Brazil. 155 voluntary blood donors and 85 HIV-seropositive homosexual and promiscuous heterosexual men were screened with ELISA for infection with HSV-2 during February-August 1994. 20 highly active prostitutes were also studied during May-July 1994. The subjects were of mean age 30 years, 70% were sexually active at the time of the study, and 6.55% used condoms. Antibodies to HSV-2 were detected in 29.1% of the blood donors, 73% of the HIV-seropositive men, and 72% of the overall high-risk group. Only 10%, however, admitted to ever having episodes of genital herpes. HSV-2 infection was significantly and independently associated with years of sexual activity, history of previous STDs, number of sex partners in the previous month, number of pregnancies, number of induced abortions, and the percentage of sex acts involving receptive anal intercourse. Routine screening for HSV-2 infection should be considered in populations at high risk for STDs.

Heterosexual transmission of HIV in Haiti.

BACKGROUND: Despite the importance of human immunodeficiency virus (HIV) transmission through heterosexual contact, the incidence of HIV infection in heterosexual cohorts has not been well studied, particularly in the developing world. OBJECTIVE: To 1) determine the incidence of HIV infection in discordant heterosexual couples (couples in which one partner had HIV infection and the other did not) in Haiti and 2) assess risk factors for and methods of preventing HIV infection. DESIGN: Prospective study. SETTING: National Institute for Laboratory Research, Portau-Prince, Haiti. PARTICIPANTS: 475 HIV-infected patients and their noninfected regular sex partners. MEASUREMENTS: Patients and their partners were evaluated at 3- to 6-month intervals for HIV infection, sexually transmitted diseases, and sexual practices. The efficacy of counseling and provision of free condoms was also evaluated. RESULTS: Among the 177 couples who remained sexually active during the prospective study period, 20 seroconversions to HIV positivity occurred, for an incidence rate of 5.4 per 100 person-years (95% CI, 5.16 to 5.64 per 100 person-years). Thirty-eight couples (21.5%) discontinued sexual activity during the study. Only 1 seroconversion occurred among the 42 sexually active couples (23.7% of the 177 sexually active couples) who always used condoms. In contrast, the incidence in sexually active couples who infrequently used or did not use condoms was 6.8 per 100 person-years (CI, 6.49 to 7.14 per 100 person-years). Transmission of HIV was associated with genital ulcer disease, syphilis, and vaginal or penile discharge in the HIV-negative partner and with syphilis in the HIV-infected partner. CONCLUSION: Counseling and the provision of free condoms contributed to the institution of safe sex practices or abstinence in 45% of discordant heterosexual couples. However, 55% of couples reported that they continued to have unprotected sex, resulting in an incidence of HIV infection of 6.8 per 100 person-years.

PIP: A prospective study of 475 individuals infected with human immunodeficiency virus (HIV) and their non-infected regular sex partners indicated that discordant heterosexual couples comprise a major source of acquired immunodeficiency syndrome (AIDS) spread in Haiti. Participants were recruited from the National Institute for Laboratory Research in Port-au-Prince. Of the 2687 HIV-positive individuals who returned to the Institute during 1988-92 to obtain their HIV test result, 1201 brought in a regular sexual partner for testing; 583 (49%) of these partners were HIV-negative. Discordant couples received free condoms and counseling and were evaluated at 3-month intervals. Sexual activity was discontinued by 298 (63%) of couples within 6 months of study entry, largely because of advanced AIDS. Overall, 20 sex partners seroconverted after a median follow-up of 27 months. Seroconversion was associated with non-use of condoms (relative risk, 6.8/100 person-years), the presence of genital ulcer disease in the initially HIV-negative partner (6.55), and syphilis in the HIV-infected index patient (2.9). Counseling increased condom use from none at study entry to 24%. The rate of seroconversion in those who always used condoms was only 1/100 person-years.

HIV-1 prevalence and risk factors among sexually transmitted disease clinic attenders in Trinidad.

OBJECTIVES: To study trends in prevalence and to ascertain risk factors for HIV-1 among sexually transmitted disease (STD) clinic attenders in Trinidad. DESIGN AND METHODS: Serial cross-sectional studies were conducted in 1987-1988 and 1990-1991 at a centralized STD clinic in Port of Spain. A case-control study was carried out to examine in greater detail the demographic and behavioral risk factors for HIV-1 among self-declared heterosexuals in this population. RESULTS: HIV-1 prevalence increased from 3.0% [95% confidence interval (CI), 2.3-3.9] in 1987-1988 to 13.6% (95% CI, 11.8-15.6) in 1990-1991. Age > or = 40 years [odds ratio (OR), 2.0; 95% CI, 1.4-2.8], urban residence (OR, 2.2; 95% CI, 1.6-3.0), and human T-lymphotropic virus-I seropositivity (OR, 3.1; 95% CI, 1.6-6.0) were significant risk factors for HIV-1 in 1990-1991. In the case-control analysis, significant independent risk factors for men included current genital ulcer disease (OR, 5.2; 95% CI, 2.2-12.5), current genital warts (OR, 3.9; 95% CI, 1.2-12.0), having ever had syphilis (OR, 3.2; 95% CI 1.6-6.1), and use of crack cocaine in the preceding 6 months (OR, 6.2; 95% CI, 2.7-14.2). Corresponding risk factors for women were commercial sex work (OR, 5.7; 95% CI, 1.3-25.7), initiation of sexual activity before age 14 years (OR, 4.8; 95% CI, 1.5-16.0), and past non-gonococcal cervicitis (OR, 4.1; 95% CI, 1.3-13.1). CONCLUSIONS: HIV-1 in this setting is primarily heterosexually transmitted in a milieu of unprotected sexual activity fuelled by a crack cocaine epidemic. Targeted interventions to prevent, detect and treat STD and crack cocaine addiction, as well as disrupt their adverse synergism, may substantially reduce HIV-1 transmission in this population.

PIP: During mid-1987 to mid-1988 and mid-1990 to mid-1991, researchers conducted cross sectional serological surveys at the STD clinic in Port of Spain in Trinidad to examine trends in HIV-1 prevalence among 2019 and 1606 STD patients, respectively. They also conducted a case control study of risk factors for HIV-1 infection among heterosexual STD patients (131 cases and 173 age- and sex-matched controls) in 1992-1993. Between 1987-1988 and 1990-1991, HIV-1 seroprevalence increased markedly (3% to 13.6%). It increased more in women than in men (9- vs. 4-fold). During 1987-1988, men were more likely to be infected with HIV-1 (odds ratio [OR] = 3.1), but by 1990-1991, gender was no longer a significant risk factor (OR = 1.3). In 1990-1991, significant risk factors for HIV-1 infection were urban residence (OR = 2.2), HTLV-1 infection (OR = 3.1), and being at least 40 years old (OR = 1.8). None of these risk factors were significant in 1987-1988. HIV-1/HTLV-1 coinfection increased between the two surveys (0.05% to 1.5%). Significant independent HIV-1 risk factors in men identified in the case control study were: used crack cocaine in the past 6 months (adjusted OR [AOR] = 6.2; p = 0.0001); ever had anal sex (AOR = 7.2; p = 0.003); ever had syphilis (AOR = 3.2; p = 0.02); current genital ulcer disease (AOR = 5.2; p = 0.0001); and current genital warts (AOR = 3.9; p = 0.02). Significant independent HIV-1 risk factors in women were: less than 14 years old at first sex (OR = 4.8; p = 0.01); ever been a commercial sex worker (AOR = 5.7; p = 0.02); and ever had nongonococcal cervicitis (AOR = 4.1; p = 0.005). These findings suggest that sexual exposure to HIV-1 through ulcers for men and inflammatory STD and/or prostitution for women, all fueled by the crack cocaine epidemic, account for much of HIV-1 exploding in Trinidad. Public health interventions to prevent, detect, and treat STDs and crack cocaine addition may greatly reduce HIV-1 transmission.

"Pink plague" changes course.

PIP: By October 1992, the government's Special Program to Control AIDS (PECOS) registered 717 cases of the disease in Peru; however, the number of acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) cases could number thousands. PECOS estimates that the number of cases of HIV is doubling every 2 years. One of the main reasons for the continued spread of HIV is the common perception that the pink plague, as AIDS is called here, affects only homosexuals. While 85% of sexually transmitted HIV and AIDS cases are among gay and bisexual men, in the past 4 years a large number of new cases has been registered among heterosexuals, especially women. In 1987, the ratio of AIDS cases among men and women was approximately 15 to 1. Today, the male to female ratio is 7 to 1. Most people working on AIDS say that the changing profile of the epidemic in Peru is caused by the high costs of prevention programs and the lack of information on the disease, which drastically raise the number of people in high risk groups. Peru's ongoing economic crisis has eaten into the budgets of nongovernment organization's (NGOs) AIDS prevention campaigns and has pushed treatment out of the reach of many people. In 1991, 3 television commercials developed by PECOS to promote the use of condoms were blocked by the Health Ministry. One of the groups that fought against campaigns promoting condom use was the Association of Catholic Doctors. The only way to organize an effective program is through a joint effort that brings together the government, NGOs, and other private and public institutions. Cooperation was demonstrated through the actions carried out for World AIDS Day, when more than 16 public, NGO, and government organizations were involved in a variety of AIDS information activities. In 1993, about 30 NGOs will begin actively working with Peru's Health Ministry to coordinate activities.^ieng

Social norms for condom use: implications for HIV prevention interventions of a KABP survey with heterosexuals in the Eastern Caribbean.

PIP: A knowledge, attitude, belief, and practices survey was given to a sample of 591 residents of St. Lucia in the fall of 1990. The survey posed a host of questions relating to whether respondents were inclined to use condoms when having sex. Respondents were sexually experienced, aged 15-60 years, and interviewed in their homes. Questions were posed and viewed as possible indicators of AIDS knowledge, cues to action, perceived susceptibility, perceived severity, perceived locus of control, normative pressure, and condom use outcome expectancies. Statistical analysis suggests that each variable is related to condom use. Analysis also indicates that perceived normative pressure to use condoms was by far the single most important determinant of condom use among the sample. The author closes by discussing the implications of these findings for designing mass media campaigns to increase condom use and strongly recommends a normative campaign.^ieng

The epidemiology of AIDS and HIV infection in Costa Rica.

This article describes and assesses the epidemiology of AIDS and HIV infection in Costa Rica. A total of 283 AIDS cases were reported in the country between 1983, when the first cases were diagnosed, and the end of August 1991. This placed Costa Rica third among the seven Central American countries--both in terms of cumulative AIDS incidence and the cumulative number of cases. Despite a continued small number of hemophilia and transfusion-associated AIDS cases, screening of blood and blood products has provided a high degree of safety for the blood supply. The high male:female ratios of reported AIDS cases (11:1) and HIV infections (14:1) and the high proportion of AIDS cases (72%) transmitted by male-to-male sexual contact give grounds for considering Costa Rica to be a Pattern I country--one where the disease is transmitted, primarily among homosexual/bisexual males. However, increasing numbers of heterosexual and perinatal cases, high rates of HIV infection among pregnant women, and existing patterns of bisexuality are consistent with a possible shift toward a Pattern I/II epidemic.

PIP: In Costa Rica, the Department of AIDS Control and Prevention of the Ministry of Health (MOH) in San Jose maintains AIDS case surveillance data and HIV seroprevalence data for the entire country. As of August 1991, 283 people had developed AIDS, for a cumulative incidence of 9.3 cases/100,000 residents in Costa Rica compared to 8.4 cases/100,000 for all Central America. 65% (183) of the AIDS cases had died. The annual incidence rate for 1990 was 2.5 cases/100,000 (77 cases). Most of the AIDS cases were concentrated in marked the first reported AIDS cases. In 1983-84, hemophiliacs were the only AIDS cases. In 1985, homosexuals joined the rank of AIDS cases and, beginning in 1986, represented the largest risk group (50-79%). The first heterosexual AIDS case was in 1986. There were no new heterosexual AIDS cases in 1987, but there were 3-5 cases each year thereafter, intravenous drug use, and perinatal transmission. 92% (260) of all 283 cases were males (male:female cumulative AIDS cases ratio = 11:1 as of August 1991). 78% (221) of all cases acquired AIDS via sexual transmission. As of August 1991, 568 people were infected with HIV (male:female ratio = 14:1). The MOH has conducted sentinel surveillance studies (sexually transmitted diseases patients, tuberculosis patients, pregnant women, HIV counseling clients, health center clients, slum residents) and population-based studies (blood donors). Currently Costa Rica holds to a classic Pattern I transmission (bisexual/homosexual transmission predominates), but the data indicate that it may eventually become a Pattern I/II epidemic (increasing numbers of heterosexual transmission cases of HIV infected pregnant women with continued presence of homosexual/bisexual transmission).

AIDS-related knowledge, attitudes, beliefs, and practices in Haiti.

AIDS constitutes an important public health problem in Haiti, where it appears to be spread mainly through heterosexual encounters. The study reported here employed in-depth interviews, focus group discussions, and a national cross-sectional survey of 1,300 men and 1,300 women 15 to 49 years old to assess AIDS-related knowledge, attitudes, beliefs, and practices in Haiti. According to criteria established for the study, 38.1% of the 1,118 sexually active male survey respondents were found to engage in high-risk behavior. In general, the women were found to have better knowledge of AIDS than the men. Significant obstacles to condom use included the inability of women to choose whether condoms would be used and a belief that condom lubricant could cause health problems. The study also found a tendency to ostracize people with AIDS, especially in areas outside Port-au-Prince, and a belief that AIDS was imposed on people by fate--which could partially explain the tendency to persist in high-risk behavior.

PIP: AIDS constitutes a major health problem in Haiti which continues to grow through what seems to be mainly heterosexual relations. Over 1989-90, 8.9% of 1720 pregnant women attending a prenatal clinic in a suburban slum were identified as HIV-seropositive. Among initial blood donors in 1990, 5.8% of 1199 males and 1.9% of 15 female donors were seropositive for HIV. In-depth interviews, focus groups, and a national cross-sectional survey of 1300 men and 1300 women aged 15-49 years were conducted in an effort to assess participants' AIDS-related knowledge, attitudes, beliefs, and practices. 38.1% of the 1118 sexually active male survey respondents engaged in high-risk behavior. Men were considered to be at high risk for infection/transmission if they had ever visited a prostitute or had more than 1 sex partner in the month preceding the interview. Most in Haiti have heard of AIDS, but many misconceptions remain about how HIV is transmitted. Women did, however, tend to better informed than men. Even though the women may be comparatively better informed about HIV transmission, their lack of ability to negotiate condom use still impedes the more widespread use of condoms. The belief that condom lubricant may cause health problems also impedes condom use. Finally, the study found a tendency to ostracize people with AIDS, especially outside of Port-au-Prince, and the belief that individuals acquire AIDS deterministically according to fate. A coordinated national effort is needed to correct these misconceptions and increase the prevalence of condom usage.

Comparison of condom breakage during human use with performance in laboratory testing.

This paper combines results from a study of the determinants of condom quality and use conducted by The Population Council in two countries in the Caribbean with results from a condom breakage study conducted by Family Health International (FHI) in the United States. The studies, conducted two years apart, compared the breakage rates of condoms from the same lot during human use to their performance in laboratory test results. Breakage rates of 12.9% for Barbados, 10.1% for St. Lucia and 6.7% for the United States compared to passing ASTM laboratory tests suggest that existing laboratory tests as used with the current pass/fail standards are either not sufficiently sensitive or not well-defined to reliably predict condom performance during human use. The study also suggests that user behaviors and practices may be a factor in condom breakage. If the condom is to be an effective method against unplanned pregnancy and STD/HIV infection, and if consumer confidence is to be retained, condom breakage during sexual intercourse must be reduced.

PIP: Family Health International (FHI) in North Carolina sampled and tested 52mm contour condoms with a reservoir tip and silicone lubrication in November 1988 and March 1990. Condoms from this same lot were used in 2 human use studies conducted in 2 Caribbean countries and in the US. The Population Council conducted 1 human use study in Barbados and St. Lucia among 50 heterosexual male condom users from each country. FHI conducted the other study in the Research Triangle area of North Carolina among 50 heterosexual male condoms users. Condom breakage rates of the human studies were high (12.9% in Barbados, 10.1% for St. Lucia, and 6.7% for North Carolina) in comparison with other studies (1-7%). Breakage did not occur due to poor storage conditions or oil based lubricant use. The researchers thought that it occurred due to men misusing the condoms or other user behaviors and practices. This belief was supported by the differences in breakage between the Caribbean men and the US men. More men experienced multiple condom breakages than those who experienced only 1 breakage. Condoms used in the study were from the same lot which passed elongation and tensile strength standards of the American Society for Testing and Materials (ASTM) in both 1988 and 1990, but failed the International Organization of Standardization (ISO) airburst tests in 1988 and just barely passed in 1990. Apparently the standards are not sensitive enough to predict increases in condom breakage. These findings suggest that the ISO standard for airburst testing is a more accurate predictor of condom quality than the ASTM standards for tensile strength and elongation. Further the breakage rates are too high given the AIDS epidemic. Moreover high breakage reduces customer confidence. In conclusion, researchers need to conduct studies on sexual behavior and practices to determine their effect on condom breakage rates.

[AIDS: the risk that must be predicted]. / El SIDA. Frente al riesgo hay que prevenir.

PIP: 9356 cases of AIDS were reported in Mexico through March 1992. Although 7971 were in men and 1385 in women, the ratio of male to female cases has declined. In 1985, 1 woman was infected for every 20 men, but by 1991 the proportion was 1 for every 5. The annual numbers of reported cases through 1992 indicate that the epidemic is abating, but reporting of AIDS cases may be delayed for up to 4 years in Mexico. The groups considered at greatest risk of AIDS have changed over time. The proportion of new cases in homosexuals has declined from 80% in the early 1980s to 40% at present. Heterosexually transmitted cases now account for around 23%. Another 17% are transmitted parenterally through transfusions or use of contaminated needles by addicts. The homosexual population has become aware of the danger, but greater attention to prevention is required for the general heterosexual population. Cases are concentrated in the Federal District, which has a rate of 30/100,000. Four states, Baja California, Jalisco, Morelos, and Yucatan, have rates of over 10/100,000, and rates in 10 states exceed 5/100,000. The mean age of reported cases is 33 years.^ieng

Early sexual experience and traditional values in Colombia.

PIP: Results on adolescent's knowledge, attitude, and practice in sexuality and reproductive health are presented from 2 surveys of 1199 middle-class youths aged 13-18 years in main cities of Colombia. Survey populations were selected from high schools and users of Family Compensation Fund. While traditional values and customs prevail among these youths, they nonetheless tend to begin sex between ages 15-18, and have little concern over the consequences of their sexual behavior. They are, moreover, quite ignorant about reproductive health. Sexuality is not thought of as part of marriage, women are expected to be virgins at marriage, and a resounding 87% of the study population rejected abortion legislation. 90% of the young men had their 1st sexual encounter with either a prostitute or domestic servant, while 90% of the young women had their 1st encounters with friends from within their social groups. Sexual relations from adolescence on were supported by 35% of the girls and 60% of the boys, 72% of the girls and 38% of the boys supported virginity, yet less than 10% were in favor of the notion of open relationships. 20% of the girls and 25% of the boys had active sex lives, with homosexuality representing 1.6% and 3.1% of the two sex groupings, respectively. Sex education is practically non-existent. Most young women know little of contraception, and fail to use it out of misconceptions regarding method safety, and fear of one's parents finding out. The young men, on the other hand, cite forgetfulness and inability to obtain contraception as reasons for use failure. Accordingly, 5% of the girls fell pregnant between ages 15-17, with 66% ending in abortion, and 18.6% of the girls and 12.3% of the boys admitted to having had a sexually transmitted disease. 55% indicated that they would not use contraceptives.^ieng

We are all people living with AIDS: myths and realities of AIDS in Brazil.

Although AIDS was expected in Brazil, no serious efforts were undertaken to prevent AIDS from taking root. Irresponsible press and media coverage highlighted the spread of AIDS within the gay community of the United States, creating an aura of immunity in Brazil to what was characterized as a "foreign" disorder. When AIDS did surface in 1983, the official response was to adopt an abstract, inappropriate, and ideological "Western" model, in which only stigmatized "others" and "minorities" were at risk of HIV infection. Brazilian health authorities subsequently downplayed the significance of the sale of contaminated blood in HIV transmission, and likewise ignored the rising rates of AIDS among Brazil's one unarguable majority group: the poor. An analysis of efforts to force the "facts" of AIDS to fit a false model's predictions leads to a clearer definition of the broader context of the Brazilian epidemic: we all are people living with AIDS, precisely because we live in this age of AIDS; it is sheer folly to discriminate against persons infected by HIV and to obstruct their participation in efforts to curtail the epidemic's spread; and the necessary response to AIDS is solidarity, not because it is poetic, but because no other response will suffice.

PIP: Despite general public and administrative awareness of AIDS since 1982, virtually nothing has been done by the Brazilian government to check its epidemic spread in Brazil. Press reports, especially in the early days of AIDS, were a mixture of reports covering the U.S. experience with AIDS and yellow journalism designed to fuel public debate, controversy, and spending on medial consumption. This mixed image of the epidemic helped portray AIDS as an affliction to others, enigmatic and somewhat exotic. Though AIDS was expected to arrive in Brazil, complacent, unconcerned officials responded in a lackadaisical manner through the veil of an abstract, inappropriate, and ideological Western-oriented model. Failing to recognize the imminently board spectrum of sexual orientation prevalent in Brazil, and in contrast to that of U.S. society, Brazilian officials tried to classify Brazilians into the easy, accepted categories of homosexual, bisexual, and heterosexual as assumed in North American and Europe. Blood supplies were eventually tainted out of this failure to take constructive action, with the resultant mass infection of segments of the Brazilian population. This author is angry with Brazilian public and private attitudes at the lowest and highest levels of administration, and indicts the bureaucratic system created by his society. Complacency, ignorance, and social discrimination have resulted in countless deaths, and continue to incur great economic costs and mortality. He calls upon society to re-examine what living with AIDS is all about, how it affects society as a whole, and recognize the crucial need to fight the war on AIDS with solidarity as a united, committed whole. AIDS is not a problem afflicting limited minority groups; it threatens major economic breakdown, especially in 3rd World countries, in the absence of universal cooperation between those infected, and those who would otherwise consider themselves immune.

Risk of health care professionals acquiring HIV infection in Latin America.

This study describes the professional risk of acquiring HIV infection while caring for AIDS patients at a teaching hospital in Brazil. Since 1985 we have tested health care professionals (HCP) for HIV-1 antibody after accidents with blood and body fluids from AIDS patients. The blood samples were tested twice using an ELISA FDA approved test and, if positive, we performed Western blot. Two hundred and forty seven health care professionals reported 338 accidents (50% were percutaneous and 22% were mucous membrane exposures to blood). A further 404 HCPs reported no occupational exposure but wanted to be tested. From 247 HCPs with at least one accident, we analyzed 115 with more than 6 months of follow up. None were HIV antibody positive. Nobody received zidovudine as a prophylaxis. Of the 404 HCPs with no accident, 6 (1.5%) were positive and had confirmed risk factors for HIV. Our results support other studies that report a low occupational risk (about 0.4%) of acquiring HIV infection.

The global AIDS situation -- updated, June 1990.

PIP: The global AIDS and HIV situation, in terms of prevalence, by region and sex, means of transmission, progress in treatment, and the tasks undertaken by the WHO Global Programme on AIDS are summarized as of June 1990. Over 250,000 cases of AIDS had been reported to WHO from over 150 countries by mid-1990. Because of under-reporting WHO estimates that actually 700,000 cases of AIDS exist. WHO predicts 1 million cases by 2000. 6-8 million persons with HIV are estimated, and 15-20 million are predicted for 2000, depending on the rate of increase in Asia and Latin America. Heterosexual transmission accounts for about 60% cases, increasing rapidly, especially in urban areas. 75-80% of cases in 2000 will have been heterosexually transmitted. Developing countries have 2/3 of current HIV infections, expected to be 75-80% in 2000. It is thought that 1 out of 20 adults in sub-Saharan Africa is HIV+. Among men, the ratio is 1 out of 75 in North America, 1 in 125 in South America, 1 in 200 in Western Europe. Among women, the ratio is 1 in 700 in North America, 1 in 500 in South America, 1 in 700 in Western Europe and 1 in 20,000 women in Eastern Europe. Progress has been made in treating HIV with antiviral drugs such as Zidovudine, and in managing complications of HIV such as Pneumocystis carinii pneumonia, Kaposi's sarcoma, and cytomegalovirus retinitis. A potential lead for a vaccine has been reported from animal research. The objectives, activities, collaborative functions and priorities of the WHO Global Programme on AIDS are summarized.^ieng

Peru: reaching boys who sell sex.

PIP: Sex educational programs should employ trained workers to reach the male adolescent population in Peru. Sexual activity for boys begins between 13-15 years which often involves a prostitute; hence, accurate sex information is needed for these adolescents. Magazines and other media forms are utilized by males to obtain sex information. These young boys are often misinformed about healthy sexual practices and contraception. Sexually transmitted diseases (STD) are a problem for male adolescents; of the 92% of high school males who were sexually active, 23% had a STD infection. Poor economic conditions have contributed to young boys' engaging in sex for money such as prostitution and "fleteo". Private institutions have improved sex education by training educators to provide information on adolescent sexuality and by working directly with street children who sell sex. These outreach programs are concerned with emotional, economic, and sexual issues. Information about AIDS and sexually transmitted diseases are also provided by these organizations.^ieng