Transactional sex risk and STI among HIV-infected female sex workers and HIV-infected male clients of FSWs in India

To describe sex risk behaviors of HIV-infected female sex workers (FSWs) and HIV-infected male clients of FSWs, to evaluate associations between risky transactional sex and number of unprotected transactional sex episodes, and to assess the association between unprotected transactional sex and self-reported sexually transmitted infection (STI). Adult HIV-infected FSWs (n = 211) and HIV-infected male clients (n = 205) were surveyed in Mumbai about demographics, STI, and past 90-day and past year sex and substance use histories. Gender-stratified Poisson regression models were used to evaluate associations between four risky transactional sex behaviors (number of transactional sex partners; alcohol use before transactional sex; anal transactional sex; and transactional sex with a known HIV-infected partner) and number of unprotected transactional sex episodes; logistic regression was used to assess the association between unprotected transactional sex and self-reported STI. Twenty-nine percent of females and 7% of males reported any unprotected transactional sex episodes in the past 90 days. Thirty-nine percent of females and 12% of males reported past year STI. Among males, a greater number of transactional sex partners was associated with more unprotected transactional sex episodes (adjusted incidence rate ratio [IRR] = 8.2, 95% confidence interval [CI] = 1.8-38.4 highest vs. lowest tertile), and any unprotected transactional sex was associated with a higher odds of self-reported STI in the past year (adjusted odds ratio [AOR] = 5.6, 95% CI = 1.4-22.4). For women, risky transactional sex behaviors were not associated with condom non-use, and unprotected sex was negatively associated with STI (AOR = 0.4, 95% CI = 0.2-0.9). Reports of condom use during transactional sex were high for these samples. However, standard predictors of unprotected transactional sex (i.e., greater number of partners) and STI (i.e., unprotected sex) only held true for males. Further research is needed to guide an understanding of sex risk and STI among HIV-infected FSWs in India.     

Sex differences and sex steroids in lung health and disease

Sex differences in the biology of different organ systems and the influence of sex hormones in modulating health and disease are increasingly relevant in clinical and research areas. Although work has focused on sex differences and sex hormones in cardiovascular, musculoskeletal, and neuronal systems, there is now increasing clinical evidence for sex differences in incidence, morbidity, and mortality of lung diseases including allergic diseases (such as asthma), chronic obstructive pulmonary disease, pulmonary fibrosis, lung cancer, as well as pulmonary hypertension. Whether such differences are inherent and/or whether sex steroids play a role in modulating these differences is currently under investigation. The purpose of this review is to define sex differences in lung structure/function under normal and specific disease states, with exploration of whether and how sex hormone signaling mechanisms may explain these clinical observations. Focusing on adult age groups, the review addresses the following: 1) inherent sex differences in lung anatomy and physiology; 2) the importance of certain time points in life such as puberty, pregnancy, menopause, and aging; 3) expression and signaling of sex steroid receptors under normal vs. disease states; 4) potential interplay between different sex steroids; 5) the question of whether sex steroids are beneficial or detrimental to the lung; and 6) the potential use of sex steroid signaling as biomarkers and therapeutic avenues in lung diseases. The importance of focusing on sex differences and sex steroids in the lung lies in the increasing incidence of lung diseases in women and the need to address lung diseases across the life span.     

Sex worker, client sex behaviour and condom use in Harare, Zimbabwe

One-hundred sex workers and 100 clients were interviewed at a bar/disco complex in Harare, Zimbabwe in 1989. Sociodemographic characteristics of sex workers and clients were examined. Almost a third of sex workers and nearly 90% of clients had engaged in commercial sex over 5 or more years. Sex workers reported that they worked an average of 4.6 nights a week, averaged 2.2 clients a night and charged a mean of Z$8.7 per session and Z$19.8 per night. Clients reported that they averaged 7.4 visits a month to a sex worker and paid a mean of Z$6.2 per session and Z$17.2 per night. Over half the sex workers said their last client was drunk and nearly two-thirds said he was a repeat client. Sex workers and clients were asked about the sex behaviours completed in their last paid sex act. Vaginal intercourse was reported by 98% of sex workers and clients alike. Manual stimulation of the sex worker's and client's genitalia was reported by roughly 80% of sex workers and clients. Oral and anal sex were rarely reported. Fifty-four percent of sex workers and 44% of clients reported using a condom in their last paid sex act. Client reports thus suggest that sex worker reports of sex acts and condom use with the last client possess considerable validity. Ethnographic approaches were used to study the social and work environment of sex workers. Ethnographic analysis demonstrated a lack of organisation among sex workers and a need to develop cohesive groups for successful health interventions. The study also highlighted the need to include clients in health interventions, the possible role of alcohol as an impediment to health interventions and the feasibility of using bar/disco security and the bar personnel as health educators.     

男男性行为人群不同性伴寻找场所HIV和梅毒感染及相关行为特征

目的了解不同性伴寻找场所男男性行为人群(MSM)艾滋病病毒(HIV)/梅毒感染状况,以及相关的行为特征。方法采用应答推动方法(RDS),在MSM活动场所定时、定点对MSM人群进行招募和询问式匿名调查,采集血样进行血清学检测。结果共调查400人,寻找性伴场所属酒吧型的占21.5%,浴室型占2.5%,公园型占11.3%,网络型占60.0%,其他型占4.5%。不同年龄、文化、职业、婚姻状态、性取向者,性伴寻找场所的差异有统计学意义(P<0.05)。52.3%酒吧型MSM年龄≤22岁,44.4%公园型年龄≥36岁;公园型MSM学历在初中及以下者占43.2%;网络型MSM学历在大专及以上者为44.5%;网络型未婚为90.4%,浴室型在婚及其他婚姻状况为60.0%。近6月性伴数≥6人、无保护性男男性行为均以其他型最高,分别为15.8%、76.5%;酒吧等其他型53.2%有主动肛交,90.8%有无保护性口交;浴室型50.0%有异性性行为,10.3%酒吧等其他型有卖性商业性行为,14.6%酒吧/浴室型有买性商业性伴,43.2%公园型性伴年龄相差≥11岁。不同场所型MSM HIV知识知晓率,是否知道性伴相关健康问题、不知道性伴相关健康状况的差异有统计学意义(P<0.05)。不同场所型MSM的HIV/梅毒累计感染率差异有统计学意义(P<0.05),浴室/其他型MSM的HIV感染率为20.7%,浴室/公园型MSM的梅毒累计感染率为36.4%。结论 MSM人群寻找性伴场所与艾滋病高危行为及HIV/梅毒感染相关,应根据不同场所MSM的人口学及性行为特征,有针对性地开展健康教育和行为干预。     

Endogenous Sex Hormones,Metabolic Syndrome,and Diabetes in Men and Women

Endogenous sex hormones predict impairments of glucose regulation. Cross-sectional studies suggest that lower levels of testosterone in men and higher levels in women increase risk of metabolic syndrome and diabetes, whereas lower levels of sex hormone binding globulin in both men and women increase risk of metabolic syndrome and diabetes. In a systematic review, we summarize existing longitudinal studies, which suggest similar patterns. However, these studies are often limited to a single sex steroid measure. Whether these associations are primarily a marker of adiposity, and whether these associations differ between younger eugonadal vs older hypogonadal adults is also uncertain. The impact of exogenous sex steroid therapy may not reflect relationships between sex hormones and impaired glucose regulation that occur without supplementation. Therefore, examination of endogenous sex steroid trajectories and obesity trajectories within individuals might aid our understanding of how sex steroids contribute to glucose regulation.     

性工作法律与艾滋病防治的国际视角分析

目的探讨有利于在性工作者人群中开展艾滋病防治的性工作法律制度。方法采用文献研究方式,针对性工作法律和艾滋病防治之间关系研究的主要国际文献开展分析。结果国际社会对性工作的立法框架可大体分为三类:禁止性法律、规范许可性法律和性工作非罪化法律。从公共卫生的角度分析,禁止性的法律使性工作地下化,不利于艾滋病防治;规范许可性法律无法有效解决未经登记的性工作者的健康问题;性工作非罪化法律可避免性工作者转入地下,并在健康卫生服务和行为干预的配合下,推动艾滋病防治工作。结论在三种性工作法律制度中,性工作非罪化的立法模式,最有利于在性工作群体中有效开展艾滋病防治工作。     

Sex differences and the effects of sex hormones on hemostasis and vascular reactivity

Thrombus formation and vasospasm are involved in the initiation of acute ischemic events in the heart. Gender differences in persons with coronary artery disease and the incidence of myocardial ischemia have been clearly documented. In addition, it is well established that sex hormones influence the risk of developing coronary artery disease. Epidemiologic studies suggest that estrogen may exert a protective effect, yet the results of recently completed and ongoing prospective trials of estrogen and hormone (estrogen + progesterone) replacement suggest that these hormones can increase thrombotic events in postmenopausal women. This review focuses on sex (gender) differences in hemostasis and vascular reactivity and on the influence that sex hormones have on these physiologic systems. This review takes the novel approach of focusing on sex differences in hemostasis and vascular reactivity in healthy premenopausal women and men of a similar age. By comparing men and women in this age group, the confounding issues of age, pathology, or decline in sex hormone levels are avoided. Animal and in vitro investigations pertinent to examining potential cellular mechanism(s) of sex hormones in mediating these sex differences are discussed. We assume there is a relationship between the normal physiologic and pathologic effects of sex hormones; elucidating sex differences in normal cardiovascular function will help clarify the basis for sex differences in the incidence and manifestations of coronary heart disease and will aid in the future development of gender-specific therapies for cardiovascular disease.     

Management of sexually transmitted diseases and HIV prevention in men at high risk: targeting clients and non-paying sexual partners of female sex workers in Benin

OBJECTIVES: Male clients of female sex workers have rarely been specific targets for HIV/sexually transmitted diseases (STD) interventions in sub-Saharan Africa. We assessed the effectiveness of outreach methodology for contacting sexual partners of female sex workers for purposes of HIV/STD prevention in Cotonou, Benin. DESIGN AND METHODS: In collaboration with owners/managers, outreach personnel and female sex workers, 404 clients were recruited on-site at prostitution venues, and provided urine samples for leukocyte esterase dipstick (LED), STD and HIV testing before having sex with female sex workers. After having sex they underwent an interview and physical examination. No payment was made for study participation. Prostitution site personnel (n = 41) and boyfriends of female sex workers (n = 56) were also recruited. RESULTS: In all 68% of the clients approached agreed to participate. On-site LED testing and free STD treatment were important factors in participation. HIV-1 prevalence was several-fold higher than in the general population in Cotonou, at 8.4, 12.2 and 16.1% in clients, personnel and boyfriends respectively, and was associated with increasing age and lack of condom use with female sex workers. Condom use rates by clients with female sex workers were non-negligible but sub-optimal, and low with regular partners. Approximately one-third of clients with regular partners also had other non-female sex worker sex partners. Boyfriends of female sex workers are of particular concern due to high numbers of partners, very low condom use rates and high HIV prevalence. CONCLUSIONS: Study findings indicate that male sex partners of female sex workers form a 'bridging population' for HIV/STD transmission both to female sex workers, as well as from female sex workers to the general population of women, particularly regular female partners.     

海南省吸毒暗娼行为学及梅毒感染调查

目的 了解海南省吸毒及暗娼行为学特征及梅毒、艾滋病感染情况。方法 对海南省妇教所的317名暗娼及海口、三亚、万宁、澄迈强制戒毒所的276名女性吸毒人员进行匿名问卷调查并进行梅毒、艾滋病血清学检测。结果（1）593名调查对象平均年龄25.36岁,317名暗娼中经常使用安全套者为154名（48.57％）,276名吸毒女性中有28名（10.14％）共用注射器吸毒,吸毒妇女中98.2 ％的人伴有卖淫,而暗娼中伴有吸毒者为14.83％;（2）吸毒及暗娼中梅毒感染率分别为31.88％及17.67％;两者均明显高于普通人群,吸毒女性中梅毒感染率则明显高于暗娼。结论 吸毒及暗娼均有明显的高危行为,梅毒感染率高,应该采取有效措施对该类人群进行相关危险行为的干预。     

Minireview: Sex differences in adult and developing brains: compensation, compensation, compensation

Despite decades of research, we do not know the functional significance of most sex differences in the brain. We are heavily invested in the idea that sex differences in brain structure cause sex differences in behavior. We rarely consider the possibility that sex differences in brain structure may also prevent sex differences in overt functions and behavior, by compensating for sex differences in physiological conditions, e.g. gonadal hormone levels that may generate undesirable sex differences if left unchecked. Such a dual function for sex differences is unlikely to be restricted to adult brains. This review will entertain the possibility that transient sex differences in gene expression in developing brains may cause permanent differences in brain structure but prevent them as well, by compensating for potentially differentiating effects of sex differences in gonadal hormone levels and sex chromosomal gene expression. Consistent application of this dual-function hypothesis will make the search for the functional significance of sex differences more productive.     

Sex Parties among Urban MSM: An Emerging Culture and HIV Risk Environment

Private sex parties are an emerging risk environment for HIV among men who have sex with men (MSM). In 2009, 103 participants who reported attending at least one sex party in Massachusetts in the prior 12 months completed an in-depth, interviewer-administered quantitative assessment. Multivariable logistic regression analyses were conducted to examine associations with having engaged in one or more serodiscordant unprotected anal sex (SDUAS) acts at the most recent sex party attended. Nearly one-third (32%) of the sample reported engaging in SDUAS at the most recent sex party attended. Adjusting for age, race/ethnicity, and educational attainment, variables associated with an increased odds of engaging in SDUAS at the most recent sex party were: total number of unprotected anal receptive sex acts at sex parties in the past 12 months, self-perception of being at-risk for transmitting or acquiring HIV, and sexual sensation seeking. Examined in the same model, if condoms were provided/available at the most recent sex party attended, participants were at a decreased odds of engaging in SDUAS at that sex party. The majority (80%) expressed an interest in HIV prevention activities for MSM who attend sex parties. HIV prevention interventions are needed to reach MSM who attend sex parties and should take into account individual and contextual factors that may contribute to sexual risk. Environmental factors in the sex party setting, in particular the presence and availability of condoms, may potentially mitigate individual-level factors such as unprotected anal sex.     

Aging and cancer mortality: Dynamics of change and sex differences

Age-related changes in cancer mortality risk are important for understanding the processes of disease and aging interaction. The extent to which these age changes differ by sex further contributes to this understanding but has not been well studied to date. We conducted a systematic examination of dynamics and heterogeneity of age changes in cancer mortality rates for the top 14 cancer sites using vital statistics from the NCHS and SEER between 1969 and 2007. We assessed patterns of age changes in site-specific mortality rates in terms of both increase (age slope) and acceleration (change in age slope) as measured by the log-log acceleration rate (LLA). We assessed sex differences in mortality rates through sex mortality rate ratios and sex differences in age changes through comparisons of the LLA by sex. The logged male-to-female mortality ratios are positive but vary substantially with age in magnitude. And the age patterns of sex ratios also vary across sites. The LLA values show similar declines and hence slowdowns of mortality increment into or during old age for both sexes for most sites and periods. Post-reproductive changes in sex differences in cancer mortality are not entirely consistent with the estrogenic hypothesis about the anticarcinogenic effects of sex hormones and suggest the utility of the multistage model of disease progression for some tumor sites. Analysis of age dynamics and sex differences in cancer mortality may modify extant aging-related theories of carcinogenesis and frame future searches for specific explanatory factors.     

Minireview: Sex chromosomes and brain sexual differentiation

The brains of males and females differ, not only in regions specialized for reproduction, but also in other regions (controlling cognition, for example) where sex differences are not necessarily expected. Moreover, males and females are differentially susceptible to neurological and psychiatric disease. What are the origins of these sex differences? Two major sources of sexually dimorphic information could lead to sex differences in brain function. Male and female brain cells carry a different complement of sex chromosome genes and are influenced throughout life by a different mix of gonadal hormones. Until recently all sex differences in the brain have been attributed to the differential action of gonadal hormones. Recent findings, however, suggest that brain cells that differ in their genetic sex are not equivalent, and that difference may contribute to sex differences in brain function. Here we discuss evidence for sex chromosome effects on both neural and nonneural systems, which together provide support for the idea that XX and XY cells differentiate even before they are influenced by gonadal hormones, and even if they are exposed to similar levels of gonadal steroids. Fortunately, new model systems for studying sex chromosome effects have recently been developed, and they should help in testing further the role of sex chromosome genes.     

Sexual Risk and Substance Use Behaviors Among African American Men Who Have Sex with Men and Women

African American men who have sex with men and women (MSMW), but who do not form a sexual identity around same-sex behavior, may experience risk for HIV infection and transmission. This paper reports cross-sectional survey findings on sexual behaviors and substance use of urban non-gay- or non-bisexual-identified African American MSMW (n = 68), who completed behavior assessment surveys using audio-computer assisted self-interviewing technology. Overall, 17.6% reported being HIV-positive. In the past 3 months, 70.6% had unprotected insertive sex with a female, 51.5% had unprotected insertive anal sex (UIAS) with a male, 33.8% had unprotected receptive anal sex (URAS) with a male, 25% had UIAS with a transgender female, and 10.3% had URAS with a transgender female. Findings indicated a bridging potential for HIV and sexually transmitted infections across groups, such that 38.2% reported concurrent unprotected sex with female and male partners and 17.6% reported concurrent unprotected sex with female and transgender female partners. In the past 3 months, 70.6% used alcohol before sex and 85% used drugs before sex. Men who used drugs before sex had a tenfold increased likelihood for unprotected sex with male partners, and men who injected drugs had a nearly fivefold increased likelihood for unprotected sex with a transgender female. Interventions to address sexual risk behaviors, especially partner concurrency, and substance use behavior for these men are warranted.     

HIV risk, seropositivity and predictors of infection among homeless and non-homeless women sex workers in Miami, Florida, USA

Although homelessness has frequently been associated with substance abuse, and has been established as a predictor of HIV risk among substance abusers, little is known about the impact of homelessness on HIV risk among female sex workers. This analysis investigated the contribution of homelessness to sexual risk taking among a sample of 485 female sex workers recruited into an HIV prevention programme in Miami, Florida, 41.6% of whom considered themselves to be currently homeless. Findings indicated that in comparison to non-homeless sex workers, significantly more homeless sex workers were daily users of alcohol and crack, and their past month sex work reflected significantly more frequent vaginal and oral sex acts, higher levels of unprotected vaginal sex and more numerous sexual activities while 'high' on drugs. At the same time, a significantly greater proportion of homeless sex workers encountered customers that refused to use condoms than did the non-homeless sex workers. There were no significant differences in HIV seropositivity between the homeless and non-homeless women (22.5 and 24.9%, respectively), primarily because the majority of the women in the study cycled in and out of homelessness.     

Sex work and risk behaviour among HIV-negative gay men

Gay men who engage in sex work may be at increased risk through risk behaviour outside the context of sex work. Among participants in the Health in Men (HIM) cohort of HIV-seronegative gay men in Sydney, 19.7% had ever engaged in sex work. Five percent reported being paid for sex in a six-month period during the study (2001-2006); a minority (18.3%) of these current sex workers reported unprotected anal intercourse (UAI) with clients and 62.0% reported UAI with any casual partners. The practice of sex work itself may not represent increased risk for HIV transmission but sex workers in this study were, nonetheless, at markedly increased risk in other aspects of their lives.     

Effects of testosterone and oestradiol on gonadectomized and intact male and female river lampreys (Lampetra fluviatilis (L.) Gray)

Pellets of testosterone (25 mg) or oestradiol-17β (25 mg) were implanted into adult gonadectomized or intact male or female river lampreys before the period of sexual maturation.Testosterone induced male secondary sex characters in gonadectomized males and intact females, and oestradiol-17β induced female sex characters in gonadectomized females and intact males. The homologous sex hormones administered to intact males and females did not accelerate the appearance of secondary sex characters except for growth of the urogenital papilla in the male. The heterologous sex hormones caused a range of effects from inhibition of certain normal changes to stimulation of characters characteristic of the other sex. There was no marked inhibition of spermiation and ovulation, and no convincing signs of a negative feedback between sex hormones and gonadotropin secretion. Oestradiol released from the implanted pellets was found to act on untreated males kept in the same tank, so oestradiol can be transferred via the water from one lamprey to another.The intestinal hypertrophy observed after gonadectomy was not counteracted by sex hormones.Oestradiol in several lampreys increased the survival beyond the time of natural death after spawning of untreated lampreys. During the period of prolonged survival the rate of reduction in length of the body was slowed down.     

Correlates of Ever had Sex and of Recent Sex among Teenagers and Young Unmarried Adults in The Democratic Republic of Congo

The future of the HIV/AIDS epidemic in the Democratic Republic of Congo will depend on the behavior that teenagers and young adults are likely to adopt. Documenting teenagers and young adults behavior can help design effective interventions. The premarital sexual activity of 13,091 teenagers and young adults aged 15-24 years was examined. Logistic regression models were used to identify the correlates of ever had sex and recent sex. Ever had sex and recent sex were associated with older individuals, males, school dropouts, those addicted to alcohol and drug use, those living alone or with friends, those involved in an income generating activity, those with low capacity to resist sex, those with low socio-economic status and those living in permissive milieu. Controlling access to alcohol and drugs, teaching teenagers skills to resist sex, getting schools involved in teaching values of abstinence and delayed sex, could impact the age at first sex and trigger the adoption of lower risk behavior.     

Sexual safety practices of massage parlor-based sex workers and their clients

The Outreach and Research in Community Health Initiatives and Development (ORCHID) project examines social and structural factors that contribute to HIV/AIDS risk among women working in Vancouver's indoor sex industry and their clients. From 2006 to 2009, two mixed method studies were undertaken in ORCHID: one exploring experiences of women working in the indoor sex industry, mainly in massage parlors, and the other exploring experiences of men as sex “buyers.” Both studies emphasize sexual health and safety, risk and protective behaviors, and related contextual factors. No analyses examining the sexual health and safety practices of massage parlor-based sex workers and clients exist in the Canadian context. To address this gap, we analyze two survey datasets – with 118 sex workers and 116 clients. Upon comparing demographics of sex workers and clients, we discuss their condom use and sexually transmitted infections (STI) and HIV testing practices. Sex workers and clients reported high rates of condom use for vaginal/anal intercourse. While both groups reported lower rates of condom use for oral sex during sex transactions, clients did so to a greater extent (p < 0.001). Condom use with noncommercial sex partners was reported to be less consistent by both groups. STI testing was higher among sex workers than clients (p < 0.001). Initiatives targeting clients of massage parlor-based sex workers for STI education and testing are needed. Future research should investigate how different types of relationships between sex workers and clients impact their sexual safety practices.     

The Relationship of Sexual Dyad and Personal Network Characteristics and Individual Attributes to Unprotected Sex Among Young Injecting Drug Users

We examine in the heterosexual partnerships (dyads) of IDUs the correlates of engaging in unprotected sex on three levels: individual attributes, social network characteristics, and dyad characteristics. Unprotected sex was significantly less likely to occur in dyads where the participant injected daily or had high safe-sex attitude scores, and in dyads where both members encouraged each other to use condoms. Unprotected sex was significantly more likely to occur in dyads that smoked crack together, shared needles with each other, and where the participant knew that the sex partner had concurrent sex partners. In the sexual dyads of IDUs there is a combined risk of unsafe injecting and unsafe sex. Both injecting and sexual risk, and their combination need to be addressed in interventions that target the sexual partnerships of IDUs. Such interventions should also aim to reduce injected and non-injected crack and other stimulant use associated with high-risk sex.