Intimate partner violence among HIV-serodiscordant couples in Durban, South Africa.

BACKGROUND: South Africa (SA) has a high prevalence rate of intimate partner violence (IPV) and HIV, both of which can be exacerbated further by HIV serodiscordancy in the couple dyad. Further exploration of the discordancy sidedness in known mediating factors, such as alcohol abuse risk and post-traumatic stress (PTS), is required. OBJECTIVES: To investigate the extent of and gender differences in IPV, alcohol abuse risk and PTS symptoms among HIV-serodiscordant couples in Durban, SA, and to analyse these further with regard to female HIV serostatus. METHODS: A cross-sectional analysis of data on 30 serodiscordant couples was conducted at the point of enrolment into a pilot study of an HIV risk reduction intervention. The statistical procedure for a dependent small sample was applied to examine gender differences in IPV, alcohol use and PTS symptoms among HIV-serodiscordant couples. RESULTS: The woman was HIV-positive in 18 (60.0%) of the 30 serodiscordant couples enrolled. Exposure to IPV differed significantly between men (28.6%) and women (89.3%) (proportional difference -0.61, 95% confidence interval (CI) -0.82 - -0.39). The Wilcoxon signed-rank test showed that PTS symptom scores differed significantly between men (median 22, interquartile range (IQR) 23) and women (median 44, IQR 28) (p=0.03). When the above analysis was stratified by female HIV serostatus, significant gender differences were found in IPV and PTS in the couples where the woman was HIV-positive. There were no significant gender differences for alcohol abuse risk. CONCLUSIONS: The findings demonstrated high levels of IPV in HIV-serodiscordant couples and a significant gender difference in mental health risk such as PTS in such relationships, particularly where the woman was HIV-positive. HIV intervention programmes should address gender-based violence and inequity among heterosexual couples.

Posttraumatic stress disorder diagnostic criteria and suicidal ideation in a South African Police sample.

OBJECTIVE: Exposure to traumatic events may precipitate suicidal ideation. Once an individual is diagnosed with PTSD, a suicide risk assessment often follows. This study explores how PTSD symptom criteria correlate with suicidal ideation in a sample of police officers. While the psychometric measures of PTSD often mirror the DSM-IV-TR criteria, focusing on exposure, symptom, and duration criteria, suicidal ideation measures often focus on concepts quite different from that. In this report the focus was on investigating how PTSD symptom criteria correlate with the suicidal ideation. METHOD: A group of South African police officers (N = 217) were assessed by means of the Posttraumatic Diagnostic Scale and a short version of the Adult Suicide Ideation Questionnaire. Linear and hierarchical regressions were used to determine which PTSD symptom criteria best predict suicidal ideation. RESULTS: Hyperarousal was the primary predictor of suicidal ideation (R(2) [adjusted] = 0.249). Intrusive thoughts added only marginally to the model, contributing a further 2.5% to the declared variance. The contributions of the other two symptom types were negligible. CONCLUSION: In this study hyperarousal correlated significantly with suicidal ideation. It is suggested that practitioners be alert to these symptoms as possible indicators of suicidal ideation. Implications for suicide risk assessment and prevention measures are discussed.

Social and health determinants of well being and life satisfaction in Jamaica.

BACKGROUND: Psychological well being and the degree of satisfaction with life are likely to affect a range of social behaviours and determine uptake of health and social services. It is important to identify the factors that inform these constructs. AIMS: We sought to identify the variables which best predicted psychological well being in the Caribbean country, Jamaica and also those associated with feelings of satisfaction with life. METHODS: Interviews were conducted on young adults aged 15-50 years as part of a sexual decision-making survey in Jamaica. Information was collected on a range of social, health and demographic variables and a measure of psychological well being--Centre for Epidemiological Studies of Depression (CES-D). Satisfaction with life was measured using a Likert scale in response to the question 'Are you satisfied with your life as a whole?' Multiple regression analyses were used to determine the predictors of psychological well being and satisfaction with life. RESULTS: There were 2580 respondents (1601 women and 979 men). The mean age was 29.7 years (standard deviation 9.2 years). Women had lower levels of psychological well being and satisfaction with life. Independent predictors of lower psychological well being were having an acute illness, having a chronic illness in women and high religious behaviour in men. Satisfaction with life was predicted by younger age, marital status and employment. CONCLUSIONS: Our findings suggest that health variables are more important for psychological well being while social circumstances are more significant for satisfaction with life. There are important gender differences in the mediation of psychological well being as well as age differences in the variables associated with satisfaction with life.

Predictors of neuropsychological performance in HIV positive women.

This study examines predictors of neuropsychological (NP) performance in a community sample of 237 HIV seropositive and seronegative women. Consistent with literature describing the NP sequelae of HIV infection in men, we expected that HIV status would predict poorer NP performance on tests assessing verbal memory, psychomotor speed and motor speed. Multiple regression analyses testing the association between HIV serostatus and NP performance and controlling for predictors including age, ethnicity, education, psychological distress, and drug and alcohol use indicated that HIV serostatus was associated with slowed psychomotor speed. Specifically, AIDS diagnosis and HIV seropositivity predicted poorer performance on tests of psychomotor speed relative to HIV seronegatives. Contrary to expectations, no relationship between HIV serostatus and either motor speed or verbal memory performance emerged. Education, ethnicity, depressive distress, recent exposure to drugs as indexed by toxicology, and alcohol use were also associated with NP performance. Given that the HIV seropositive and seronegative samples differed on a number of demographic and drug use variables, a second series of analyses examining a subset of participants (matched on all key demographic factors) and with no illicit drug use during the past year was also conducted. Results of these analyses were similar to those obtained for the full sample, with AIDS diagnosis and HIV seropositivity predicting psychomotor slowing. To date, little work describing the NP sequelae of HIV infection in women has been conducted. This study provides one of the first descriptions of the NP effects of HIV/AIDS in a largely non-injection drug using community sample of women.

Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors.

BACKGROUND: Tissue-sparing approaches to primary treatment and reconstructive options provide improved cosmetic outcomes for women with breast cancer. Earlier research has suggested that conservation or restitution of the breast might mitigate the negative effects of breast cancer on women's sexual well-being. Few studies, however, have compared psychosocial outcomes of women who underwent lumpectomy, mastectomy alone, or mastectomy with reconstruction. To address some of these issues, we examined women's adaptation to surgery in two large cohorts of breast cancer survivors. METHODS: A total of 1957 breast cancer survivors (1-5 years after diagnosis) from two major metropolitan areas were assessed in two waves with the use of a self-report questionnaire that included a number of standardized measures of health-related quality of life, body image, and physical and sexual functioning. All P: values are two-sided. RESULTS: More than one half (57%) of the women underwent lumpectomy, 26% had mastectomy alone, and 17% had mastectomy with reconstruction. As in earlier studies, women in the mastectomy with reconstruction group were younger than those in the lumpectomy or mastectomy-alone groups (mean ages = 50.3, 55.9, and 58.9, respectively; P: =.0001); they were also more likely to have a partner and to be college educated, affluent, and white. Women in both mastectomy groups complained of more physical symptoms related to their surgeries than women in the lumpectomy group. However, the groups did not differ in emotional, social, or role function. Of interest, women in the mastectomy with reconstruction group were most likely to report that breast cancer had had a negative impact on their sex lives (45.4% versus 29.8% for lumpectomy and 41.3% for mastectomy alone; P: =. 0001). CONCLUSIONS: The psychosocial impact of type of primary surgery for breast cancer occurs largely in areas of body image and feelings of attractiveness, with women receiving lumpectomy experiencing the most positive outcome. Beyond the first year after diagnosis, a woman's quality of life is more likely influenced by her age or exposure to adjuvant therapy than by her breast surgery.

Sexuality following breast cancer.

This article provides sex and marital therapists with detailed, multifaceted descriptions of sexuality after breast cancer based on survey responses from 863 breast cancer survivors. One third of women reported that breast cancer had had a negative impact on her sex life, and most reported negative changes in at least some areas. Nonetheless, breast cancer survivors did not differ from age-matched, healthy women on a standard measure of sexuality. Women who were most likely to report a negative impact on sexuality from cancer were those who had experienced changes in hormonal status, problems in their relationships, and difficulties with vaginal dryness. On the basis of these findings, we offer suggestions for health professionals and therapists treating breast cancer survivors.

The prevalence and circumstances of child sexual abuse: changes across a decade.

OBJECTIVE: This study reports the prevalence of child sexual abuse of African American and European American women and compares the circumstances of these incidents to data collected a decade ago. METHOD: Stratified probability sampling was used to recruit comparable samples of African American and European American women in Los Angeles County for a larger study of women's sexual decision making. Incidents of contact abuse were obtained from women 18 to 36 years old in 1994 and compared to women with those demographic characteristics from a comparable 1984 dataset. The prevalence of abuse, characteristics of the victim, assault, alleged perpetrator, disclosure, and long-term effects by ethnic group affiliation were assessed. RESULTS: Of the total sample, 34% reported at least one incident prior to age 18. Ethnic differences were found with respect to prevalence, location of abuse, and number of incidents of rape. While comparisons made with the 1984 dataset revealed no significant difference in prevalence rates over the 10 year period, changes in circumstances were noted. CONCLUSIONS: Although the prevalence of child sexual abuse in Los Angeles County remained fairly stable, several circumstances of abuse underwent change. These characteristics are discussed in relation to how sexual abuse among ethnically diverse samples in Los Angeles County has changed over a decade and how these differences can help better tailor prevention messages to different communities.

Experiences and socialization of Jamaican men with multiple sex partners.

One of the goals of the Acquired Immunodeficiency Syndrome (AIDS) control programme in Jamaica is to encourage persons to have a single sex partner. Before this can be achieved in men, it is important to identify the demographic characteristics as well as the sexual attitudes and socialization of men who have multiple sex partners. A national survey was conducted on sexual decision-making in Jamaica in which a random sample of 3,001 persons was selected for study and of 2,580 (86%) interviewed 979 were men. The following analyses included the 769 men who were sexually active. Thirty-four per cent (34%), 95% CI, 30.6-37.4%) of these men said that they were currently having sex with more than one woman. Although condom use was higher in men with multiple sex partners, 33% of them said that they never used condoms. Independent predictors of having multiple sex partners were: not being in a stable union; being raised by fathers only; and having a secondary school education. There was no significant association with church attendance or with occupation. Compared with other males, men who had multiple sex partners started having sex at an earlier age and were more likely to engage in high-risk sex behaviours such as having sex with prostitutes and abusing drugs prior to coitus. They were also more likely to believe in the use of sex as a means to control their partners and were less likely to think that being married or involved in a long-term relationship was important. These data must be taken into consideration by the AIDS control programme in Jamaica when formulating policies to promote monogamy. There may also be a need to implement parenting support or education programmes for single men who raise their sons.

Life after breast cancer: understanding women's health-related quality of life and sexual functioning.

PURPOSE: To describe the health-related quality of life (HRQL), partner relationships, sexual functioning, and body image concerns of breast cancer survivors (BCS) in relation to age, menopausal status, and type of cancer treatment. PATIENTS AND METHODS: A cross-sectional sample of BCS in two large metropolitan areas was invited to participate in a survey study that included the following standardized measures: the RAND 36-Item Health Survey; the Centers for Epidemiologic Studies-Depression Scale (CES-D); the Dyadic Adjustment Scale (DAS); the Breast Cancer Prevention Trial (BCPT) Symptom Checklist; the Watts Sexual Functioning Questionnaire (WSFQ); and subscales from the Cancer Rehabilitation Evaluation System (CARES). RESULTS: Eight hundred sixty-four BCS completed the survey. RAND Health Survey scores were as good or better than those of healthy, age-matched women, and the frequency of depression was similar to general population samples. Marital/partner adjustment was similar to normal healthy samples, and sexual functioning mirrored that of healthy, age-matched postmenopausal women. However, these BCS reported higher rates of physical symptoms (eg, joint pains, headaches, and hot flashes) than healthy women. Sexual dysfunction occurred more frequently in women who had received chemotherapy (all ages), and in younger women who were no longer menstruating. In women > or = 50 years, tamoxifen therapy was unrelated to sexual functioning. CONCLUSION: BCS report more frequent physical and menopausal symptoms than healthy women, yet report HRQL and sexual functioning comparable to that of healthy, age-matched women. Nevertheless, some survivors still experience poorer functioning, and clinicians should inquire about common symptoms to provide symptomatic management or counseling for these women.

Sexual functioning and intimacy in African American and white breast cancer survivors: a descriptive study.

This study examines ethnic differences in sexual socialization and attitudes, sexual history and current practices, and the effects of treatment in 147 African American and White breast cancer survivors. Sex-related research in younger healthy populations has shown that cultural values associated with ethnicity influence sexual functioning, but small numbers of African American participants in previous research in breast cancer survivors has limited what we know about that population. In this study, there were few differences between the 2 ethnic groups in a predominantly well-educated, high-income, highly functional sample. However, African American women were significantly less likely to be comfortable with and to practice oral sex, self-touching, and masturbatory behaviors. White women were more likely to report that breast cancer had a negative impact on their sex lives. These differences in sexual repertoire and functioning should be noted by health care practitioners treating the sexual sequelae of breast cancer treatment.

Working women's sexual risk taking in Jamaica.

Although the rates of HIV are increasing among female populations in developing countries, there is little information available about factors influencing sexual risk taking among working class women. This paper describes some of the issues discussed by two groups of 58 women working in Jamaica: Informal Commercial Importers and women working in the Freezone. These women discuss their economic vulnerability, expectations about the role of men as providers, multiple partners, perceptions of children as resources and concern about physical abuse as factors that could influence decisions about condom use. The implications of these findings are discussed for their impact on intervention programs targeting working class women in Jamaica.

Characteristics of Jamaicans who smoke marijuana before sex and their risk status for sexually transmitted diseases.

Because of the high prevalence of marijuana smoking in Jamaica, it is important to know if this practice is associated with increased risk for STD infections. A national sample of 2 580 randomly selected Jamaicans, aged 15 to 49 years were administered a questionnaire to measure a number of health and behavioural variables. The results indicated that more persons who smoked marijuana before sex had a history of STD infections than non-marijuana smokers, the difference was significant among men (46% vs 26%, p < 0.001) but not among women (19% vs 8%, p = 0.09). There was no difference in age, however, more of the smokers were unmarried, poorly educated and unemployed than persons who did not smoke marijuana before sex. They were also more likely to engage in high risk sex behaviours and other risk taking behaviors than non-smokers. The results of multiple logistic regression analyses indicated that marijuana smoking before sex was an independent risk factor for STDs among men (Odds Ratio = 2.0, p = 0.04). Although it was not possible to determine if the association was causal, the increased risk for STDs among men who smoke marijuana before sex should be incorporated into the Jamaican STD/AIDS control programme by making special efforts to encourage condom use among marijuana smokers.

Characteristics of Jamaicans who smoke marijuana before sex and their risk status for sexually transmitted diseases

Because of the high prevalence of marijuana smoking in Jamaica, it is important to know if this practice is associated with increased risk for STD infections. A national sample of 2,580 randomly selected Jamaicans, aged 15 to 49 years were administered a questionnaire to measure a number of health and behavioural variables. The results indicated that more persons who smoked marijuana before sex had a history of STD infections than non-marijuana smokers, the difference was significant among men (46 percent vs 26 percent, p < 0.001) but not among women (19 percent vs 8 percent, p = 0.09). There was no difference in age, however, more of the smokers were unmarried, poorly educated and unemployed than persons who did not smoke marijuana before sex. They were also more likely to engage in high risk sex behaviours and other risk taking behaviors than non-smokers. The results of multiple logistic analyses indicated that marijuana smoking before sex was an independent risk factor for STDs among men (Odd Ratio = 2.0, p = 0.04). Although it was not possible to determine if the association was causal, the increased risk for STDs among men who smoke marijuana before sex should be incorporated into the Jamaican STD/AIDS control programme by making special efforts to encourage condom use among marijuana smokers

Risk-taking and abusive behaviors among ethnic minorities.

The health status and health outcomes of many ethnic minorities have remained poor, or have deteriorated, despite massive health promotion campaigns. Multiple factors that encourage ethnic minorities to engage in high-risk behaviors and those that discourage health promotive behaviors must be closely examined before any health interventions are likely to be successful in decreasing substance abuse, high-risk sex, accidental deaths and injuries, and violence. Cultural and contextual factors may put some ethnic minorities in jeopardy and at higher risk for poorer health than their White counterparts (B. W. K. Yee, 1995, in press). This review article identifies contributing factors in high-risk behaviors and highlights research gaps for Americans of African, Indian, Asian and Pacific Islander, and Hispanic descent.

Office abortion services for women: private physician providers.

Research suggests that private physician providers of office abortions and the women who seek their services are not included in nationwide surveys of abortion statistics. This study describes the demographic characteristics of private physicians and the prevalence of abortions performed in their offices in Los Angeles County, California, a state in which office abortions are prohibited by law. Factors that influence physicians' decisions to provide the service, as well as the age and ethnicity of the office abortion recipients, are examined. Of 1,004 California Medical Association members who practiced obstetrics and gynecology in Los Angeles County during 1990, 49% returned anonymous, confidential surveys. Seventy percent of physicians had performed at least one abortion in California, and 29% were currently providing this service in their offices. Physician gender, age, ethnicity, and religion were associated with performing abortions. The average abortion patient was not young and ethnic, but White, middle-class, and in her mid- to late twenties. The implications of these findings are discussed.

The sociocultural relevance of sex research. Challenges for the 1990s and beyond.

This article discusses six factors influencing research on sex and reproductive health: (a) the selection of grouping variables on the basis of race; (b) conceptual frameworks to examine sexual risk taking; (c) use of recreational rather than procreation-based models of sex; (d) research designed to control rather than to understand sexual behaviors; (e) use of a dominant, male perspective; and (f) the focus on women to minimize sexual risk taking. The effect of these factors on what is understood about sociocultural, ethnic, gender, and other issues that have yet to be examined is presented, with the ultimate goal of maximizing sexual health for diverse populations.

Sexual harassment and prior sexual trauma among African-American and white American women.

This study examined the relationship between sexual harassment in work, educational, and social settings and sexual abuse in childhood and/or adulthood in a stratified community sample of 248 African-American and white American women. The cumulative impact of sexual victimization on women's sense of general well-being was also examined. Those most likely to be sexually harassed in work and social settings were women with contact sexual abuse histories, regardless of ethnicity. The work status of harassers of women with sexual abuse histories differed significantly by ethnic group. Although women with prior sexual abuse experiences from both ethnic groups most frequently reported a response to sexual harassment at work, they least frequently did so in social settings. A history of childhood sexual abuse was more negatively associated with African- American women's well-being than were repeated experiences of sexual violence. Future research should address the implications of ethnic and cultural issues on the cumulative impact of incidents of sexual violence on women of color.

Psychological factors in abortion. A review.

Psychological research is increasingly involved in debates regarding abortion. While recognizing the diversity of ethical and moral issues intertwined with abortion, the American Psychological Association (APA) has focused its involvement on psychological factors, most recently by appointing an expert panel to review the literature on psychological effects. This article notes the history of APA involvement and reports on the panel's conclusions. It presents evidence that abortion is not likely to be followed by severe psychological responses and that psychological aspects can best be understood within a framework of normal stress and coping rather than a model of psychopathology. Correlates of more negative responses following abortion are also discussed.