RESUMEN
OBJECTIVES: To describe levels of risky sexual behaviour, HIV testing and HIV knowledge among men and women in Guatemala by ethnic group and to identify adjusted associations between ethnicity and these outcomes. DESIGN: Data on 16,205 women aged 15-49 and 6822 men aged 15-59 from the 2008-2009 Encuesta Nacional de Salud Materno Infantil were used to describe ethnic group differences in sexual behaviour, HIV knowledge and testing. We then controlled for age, education, wealth and other socio-demographic factors in a multivariate logistic regression model to examine the effects of ethnicity on outcomes related to age at sexual debut, number of lifetime sex partners, comprehensive HIV knowledge, HIV testing and lifetime sex worker patronage (men only). RESULTS: The data show low levels of risky sexual behaviour and low levels of HIV knowledge among indigenous women and men, compared to other respondents. Controlling for demographic factors, indigenous women were more likely than other women never to have been tested for HIV and to lack comprehensive HIV knowledge. They were less likely to report early sexual debut and three or more lifetime sexual partners. Indigenous men were more likely than other men to lack comprehensive HIV knowledge and demonstrated lower odds of early sexual debut, 10 or more lifetime sexual partners and sex worker patronage. CONCLUSIONS: The Mayan indigenous population in Guatemala, while broadly socially vulnerable, does not appear to be at elevated risk for HIV based on this analysis of selected risk factors. Nonetheless, low rates of HIV knowledge and testing may be cause for concern. Programmes working in indigenous communities should focus on HIV education and reducing barriers to testing. Further research into the factors that underlie ethnic self-identity and perceived ethnicity could help clarify the relative significance of these measures for HIV risk and other health outcomes.
Asunto(s)
Etnicidad/estadística & datos numéricos , Infecciones por VIH/diagnóstico , Conductas Relacionadas con la Salud/etnología , Conocimientos, Actitudes y Práctica en Salud/etnología , Sexo Inseguro/etnología , Adolescente , Adulto , Coito , Etnicidad/psicología , Femenino , Guatemala/etnología , Infecciones por VIH/etnología , Humanos , Indígenas Centroamericanos , Masculino , Persona de Mediana Edad , Parejas Sexuales , Adulto JovenRESUMEN
Female sex workers (FSWs) experience elevated risk for HIV and sexually transmitted infections (STIs) through unprotected sex with male clients, yet the complexity of these commercial relationships remains understudied. From 2010 to 2011, we explored FSWs' conceptualizations of various client types and related risk behavior patterns using semistructured interviews with 46 FSWs in Tijuana and Ciudad Juarez, Mexico, where FSWs' HIV/STI prevalence is increasing. Our grounded theory analysis identified four types of commercial relationships: nonregular clients, regular clients and friends, clients who "fell in love" with FSWs, and long-term financial providers who often originated from the United States. As commercial relationships developed, clients' social and emotional connections to FSWs increased, rendering condom negotiation and maintaining professional boundaries more difficult. Drug abuse and poverty also influenced behaviors, particularly in Ciudad Juárez, where lucrative U.S. clients were increasingly scarce. While struggling to cultivate dependable relationships in a setting marked by historical sex tourism from a wealthier country, some FSWs ceased negotiating condom use. We discuss the need for HIV/STI research and prevention interventions to recognize the complexity within FSWs' commercial relationships and how behaviors (e.g., condom use) evolve as relationships develop through processes that are influenced by local sociopolitical contexts and binational income inequality.
Asunto(s)
Relaciones Interpersonales , Trabajadores Sexuales/psicología , Sexo Inseguro/etnología , Adulto , Condones/estadística & datos numéricos , Femenino , Humanos , México/etnología , Persona de Mediana Edad , Negociación/psicología , Estados Unidos , Adulto JovenRESUMEN
BACKGROUND: Behaviour and related health outcomes of migrants have been suggested to shift towards the practices of the indigenous population of the host country. To investigate this, we studied generational differences in sexual behaviour between first- and second-generation migrants (FGMs and SGMs) in The Netherlands. METHODS: In 2003-05, persons aged 16-70 years with origins in Surinam, the Antilles and Aruba were interviewed on their sexual behaviour in The Netherlands and their country of origin. The relationship of generation, age at migration and sexual behaviour was studied by multinomial logistic regression analyses. RESULTS: Generational differences were observed regarding concurrent partnerships, anal sex and history of sexually transmitted infection. Compared with FGMs who migrated at an age >25 years, those who migrated between 10 and 25 years of age were more likely to report concurrency [odds ratio (OR): 1.52, 95% confidence interval (CI): 1.14-2.04], whereas SGMs were less likely to report concurrency (OR: 0.65, 95% CI: 0.43-0.98). FGMs who migrated before the age of 10 were more likely to have had anal sex (OR: 1.90, 95% CI: 1.34-2.71) or a sexually transmitted infection diagnosis (OR: 1.80, 95% CI: 1.20-2.71) than those who had migrated at >25 years of age. CONCLUSION: Our study shows that not only SGMs but also FGMs who migrated at an early age tend to differ from the sexual patterns of FGMs who migrated at an older age. Generational differences in sexual behaviour could be explained by acculturation and increased identity with the values of the host country.
Asunto(s)
Migrantes/estadística & datos numéricos , Sexo Inseguro/estadística & datos numéricos , Serodiagnóstico del SIDA/estadística & datos numéricos , Aculturación , Adolescente , Adulto , Factores de Edad , Anciano , Infecciones por VIH/psicología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Persona de Mediana Edad , Países Bajos/epidemiología , Asunción de Riesgos , Conducta Sexual/etnología , Conducta Sexual/psicología , Conducta Sexual/estadística & datos numéricos , Suriname/etnología , Migrantes/psicología , Sexo Inseguro/etnología , Sexo Inseguro/psicología , Indias Occidentales/etnología , Adulto JovenRESUMEN
We examined structural factors-social, political, economic, and environmental-that increase vulnerability to HIV among indigenous people in the Peruvian Amazon. Indigenous adults belonging to 12 different ethnic groups were purposively recruited in four Amazonian river ports and 16 indigenous villages. Qualitative data revealed a complex set of structural factors that give rise to environments of risk where health is constantly challenged. Ferryboats that cross Amazonian rivers are settings where unprotected sex-including transactional sex between passengers and boat crew and commercial sex work-often take place. Population mobility and mixing also occurs in settings like the river docks, mining sites, and other resource extraction camps, where heavy drinking and unprotected sex work are common. Multilevel, combination prevention strategies that integrate empirically based interventions with indigenous knowledge are urgently needed, not only to reduce vulnerability to HIV transmission, but also to eliminate the structural determinants of indigenous people's health.
Asunto(s)
Infecciones por VIH/etnología , Infecciones por VIH/transmisión , Grupos de Población/etnología , Enfermedades de Transmisión Sexual/etnología , Enfermedades de Transmisión Sexual/transmisión , Medio Social , Factores Socioeconómicos , Adolescente , Adulto , Intoxicación Alcohólica/complicaciones , Intoxicación Alcohólica/etnología , Coito , Femenino , Identidad de Género , Conocimientos, Actitudes y Práctica en Salud , Homosexualidad , Humanos , Masculino , Perú , Política , Factores de Riesgo , Trabajo Sexual/etnología , Marginación Social , Sexo Inseguro/etnología , Adulto JovenRESUMEN
This study examines the prevalence of miscarriage/stillbirth among female sex workers who inject drugs (FSW-IDUs) and measures its associations with physical and sexual violence. Baseline data from 582 FSW-IDUs enrolled in an HIV intervention study in Tijuana and Ciudad Juárez, Mexico were used for current analyses. 30% of participants had experienced at least one miscarriage/stillbirth, 51% had experienced sexual violence, and 49% had experienced physical violence. History of miscarriage/stillbirth was associated with sexual violence (adjusted odds ratio [aOR] = 1.7, p = .02) but not physical violence. Additional reproductive risks associated with miscarriage/stillbirth included high numbers of male clients in the previous month (aOR = 1.1 per 30 clients, p = 0.04), history of abortion (aOR = 3.7, p < .001), and higher number of pregnancies (aOR = 1.4 per additional pregnancy, p < .001). Programs and research with this population should integrate reproductive health and consider gender-based violence.
Asunto(s)
Aborto Espontáneo/epidemiología , Americanos Mexicanos/estadística & datos numéricos , Complicaciones del Embarazo/epidemiología , Delitos Sexuales/estadística & datos numéricos , Trabajadores Sexuales/psicología , Trabajadores Sexuales/estadística & datos numéricos , Medio Social , Mortinato/epidemiología , Abuso de Sustancias por Vía Intravenosa/epidemiología , Migrantes/estadística & datos numéricos , Violencia/estadística & datos numéricos , Aborto Inducido/estadística & datos numéricos , Aborto Espontáneo/etnología , Aborto Espontáneo/prevención & control , Adolescente , Adulto , California , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , México/etnología , Persona de Mediana Edad , Embarazo , Complicaciones del Embarazo/etnología , Complicaciones del Embarazo/prevención & control , Factores de Riesgo , Delitos Sexuales/etnología , Delitos Sexuales/prevención & control , Trabajadores Sexuales/educación , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/etnología , Enfermedades de Transmisión Sexual/prevención & control , Mortinato/etnología , Abuso de Sustancias por Vía Intravenosa/etnología , Abuso de Sustancias por Vía Intravenosa/prevención & control , Sexo Inseguro/etnología , Sexo Inseguro/estadística & datos numéricos , Violencia/etnología , Violencia/prevención & control , Adulto JovenRESUMEN
This study explored, from a public health perspective, factors that contribute to inconsistent condom use by men in Curaçao through semi-structured face-to-face interviews with 21 heterosexual men. The findings show that there is an important disconnect between what is considered culturally appropriate sexual behaviour for men and women and condom use, that diverging from prescribed notions of masculinity and femininity in order to use condoms consistently is difficult, and that condom use is particularly problematic in the context of concurrent partnerships and sexual economic exchanges. Participants further reported that Caribbean family structures, whereby mothers assume the role as primary caregiver and fathers contribute biologically but, to a much lesser extent socially, also have an impact on condom use. Additionally, consistent condom use was reported to be impeded by a cultural taboo on talking seriously about sex and sexual health. In their totality, findings provide important input from men for the development of sexual health promotion interventions that are cognizant of the cultural context in which inconsistent condom use occurs, and that are geared not only to the individual level but also to the interpersonal and structural levels.
Asunto(s)
Condones/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud/etnología , Heterosexualidad/psicología , Hombres/psicología , Sexo Inseguro/psicología , Adolescente , Adulto , Heterosexualidad/etnología , Humanos , Masculino , Masculinidad , Persona de Mediana Edad , Antillas Holandesas , Investigación Cualitativa , Factores de Riesgo , Asunción de Riesgos , Sexo Inseguro/etnología , Adulto JovenRESUMEN
Indigenous migrant workers (IMWs) have a high vulnerability to HIV and STDs due to poverty and marginalization. This study examined factors associated with sexual risk behavior (SRB) according to type of partner in transnational young male IMWs at a sugar cane agro-industrial complex in western Mexico. A total of 192 sexually active IMWs were recruited from four laborer shelters to participate in a sexual partner survey. The IMWs were interviewed about their sexual partners and practices over the last 12 months during which it emerged that they had had a total of 360 sexual partners. Multiple linear regression analyses were performed to identify factors related to SRB in 222 main (spouse, mistress and girlfriend) and 138 casual partners (colleague, friend, casual encounter and sex worker). Results showed a significantly higher SRB score with casual partners. For the main partner regression model, prior exposure to HIV- and STD-preventive information and sexual intercourse with higher employment status partners (formal workers vs. self-employed in informal activities and unemployed) were associated with lower SRB scores, but if the sexual relations occurred in Mexico (vs. the U.S.), the SRB scores increased. For the casual partner model, the practice of survival sex (sex in exchange for basic needs), sexual relations in Mexico (vs. the U.S.), and being a circular migrant (person traveling for temporary work to return home when the contract is over) were related to higher SRB scores. Findings support the implementation of preventive interventions using different messages depending on the type of partners, main or casual, within the labor migrant context.
Asunto(s)
Parejas Sexuales/psicología , Migrantes/psicología , Sexo Inseguro/etnología , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Entrevistas como Asunto , Modelos Lineales , Masculino , Estado Civil , México/epidemiología , México/etnología , Marginación Social/psicología , Migrantes/estadística & datos numéricos , Sexo Inseguro/psicología , Sexo Inseguro/estadística & datos numéricos , Adulto JovenRESUMEN
Utilizing the concept of race-based traumatic stress, this study tested whether posttraumatic stress symptoms explain the process by which perceived discrimination is related to health risk behaviors among Mexican American adolescents. One hundred ten participants were recruited from a large health maintenance organization in Northern California. Mediational analyses indicated that adolescents who perceived more discrimination reported worse posttraumatic stress symptoms, controlling for covariates. In turn, adolescents who experienced heightened posttraumatic stress symptoms reported more alcohol use, more other drug use, involvement in more fights, and more sexual partners. Perceived discrimination was also directly related to involvement in more fights. Results provide support for the notion of race-based traumatic stress, specifically, that perceived discrimination may be traumatizing for Mexican American adolescents. Counseling psychologists and counselors in schools and community settings should assess Mexican American adolescents for the effects of discrimination and provide appropriate interventions to reduce its negative emotional impact.
Asunto(s)
Conductas Relacionadas con la Salud/etnología , Americanos Mexicanos/psicología , Prejuicio , Asunción de Riesgos , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/etnología , Aculturación , Adolescente , Agresión/psicología , Consumo de Bebidas Alcohólicas/etnología , Consumo de Bebidas Alcohólicas/psicología , California , Consejo , Femenino , Sistemas Prepagos de Salud , Humanos , Estudios Longitudinales , Masculino , Inventario de Personalidad , Factores Socioeconómicos , Trastornos por Estrés Postraumático/psicología , Trastornos por Estrés Postraumático/terapia , Trastornos Relacionados con Sustancias/etnología , Trastornos Relacionados con Sustancias/psicología , Sexo Inseguro/etnologíaRESUMEN
This study's interest relies on adolescents' social representations of unprotected sex, more precisely on the relationship between the attitude towards the preservative and the reason attribution for its non use. 1386 secondary school students took part in the study, in the Brazilian cities of Florianópolis, Itajaí and Balneário Camboriú. In order to verify reasons attributed by the students, we focused on the sample that had sexual experiences without using the condom during last year. Data was analyzed with software ALCESTE, which showed three different classes of explanations for the non use of the preservative: the moment of the intercourse (unpredictable and incontrollable), trust in the partner and the option of the contraceptive pill, instead of the preservatives, in avoiding pregnancy. The students' attitudes towards the preservative are less favourable among those who maintain sexual intercourse with known people. The results revealed two representations of AIDS: one of trust in the partner and another of the experience with sex and the preservative--the first one gives sense to the adolescents' experiences with known sexual partners and the second, with less known sexual partners.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/prevención & control , Síndrome de Inmunodeficiencia Adquirida/psicología , Sexo Inseguro/etnología , Sexo Inseguro/psicología , Síndrome de Inmunodeficiencia Adquirida/etnología , Adolescente , Brasil , Condones/estadística & datos numéricos , Conducta Anticonceptiva , Cultura , Femenino , Conocimientos, Actitudes y Práctica en Salud , Encuestas Epidemiológicas , Humanos , Masculino , Embarazo , Embarazo en Adolescencia/prevención & control , Embarazo en Adolescencia/psicología , Parejas Sexuales/psicología , ConfianzaRESUMEN
O presente estudo explora as percepções e práticas sexuais entre jovens no Moçambique pós-colonial e pós-socialista, especificamente na cidade de Maputo. Usando uma combinação de diferentes métodos qualitativos, o estudo analisa profundamente relações de namoro. As relações de namoro, onde a relação sexual toma, preferencialmente, a forma de sexo não protegido (sem o uso do preservativo) - "sexo verdadeiro" - são reciprocadas pelo amor e pela proposta de um compromisso por parte do jovem. Assim, verifica-se um sistema de trocas de presentes que neste estudo é analisado a partir do quadro teórico do dom de Marcel Mauss (1969). Mas, devido ao fato de a grande maioria dos jovens que participaram do estudo praticar a monogamia serial e à existência de parceiros ocasionais com quem o sexo protegido nem sempre é praticado, existem potenciais grandes riscos para infecção com ITSs e HIV/Aids. Assim, a troca de amor por sexo constitui um presente perigoso, pois põe em risco a saúde e a vida desses jovens.
This study explores the perceptions and the sexual practices of young men and women in post colonial and post socialist Mozambique, specifically in Maputo city. Using a combination of various qualitative methods, the study performs an in-depth analysis of stable relationships called namoro. The namoro relationships, where people preferably engage in non-protected sex (no condom use) - "real sex" are exchanged by the declaration of love and the proposal for a serious commitment from the young man to the young woman. Therefore, there is a gift exchange system which, in this study, is analyzed under the theoretical framework of the gift of Marcel Mauss (1969). However, since a great part of the young people in this study practice serial monogamy and due to the existence of occasional partners with whom protected sex is not always practiced, there are potential risks to STIs and HIV/Aids infection. Thus, the exchange of sex for love is translated into a very dangerous gift, as it puts the health and the lives of these youngsters at risk.
Asunto(s)
Humanos , Conducta Sexual/etnología , Enfermedades de Transmisión Sexual/psicología , VIH , Sexualidad , Sexo Inseguro/etnología , Amor , Mozambique , Condones , ConfianzaRESUMEN
This study examined mobility on the airbridge between New York (NY) and Puerto Rico (PR) for Puerto Rican drug users and its relationship to HIV risk. Over 1,200 Puerto Rican injection drug users (IDUs) and crack smokers were recruited by outreach workers in NY and PR; interview data included questions on mobility (lifetime residences and recent trips). Two-thirds of the NY sample had lived in PR; one-quarter of the PR sample had lived in NY; the most commonly sited reasons for moving were family-related. Fewer than 10% had visited the other location in the prior 3 years. Variables related to risk were number of moves, recent travel, and having used drugs in PR (all with p < 0.05). Implications included the need to enhance risk reduction efforts for IDUs in PR and address sexual risk among mobile drug users.
Asunto(s)
Emigración e Inmigración/estadística & datos numéricos , Infecciones por VIH/etnología , Hispánicos o Latinos/psicología , Dinámica Poblacional/estadística & datos numéricos , Asunción de Riesgos , Viaje/estadística & datos numéricos , Adolescente , Adulto , Análisis de Varianza , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Puerto Rico/epidemiología , Puerto Rico/etnología , Factores de Riesgo , Abuso de Sustancias por Vía Intravenosa/epidemiología , Abuso de Sustancias por Vía Intravenosa/etnología , Abuso de Sustancias por Vía Intravenosa/virología , Encuestas y Cuestionarios , Migrantes/estadística & datos numéricos , Sexo Inseguro/etnologíaRESUMEN
Sexual risk variability among brothel-based sex workers has been shown to be influenced by fear of HIV transmission, and by culture-bound gender norms as well as economic need, yet the effect of sexual agency on impoverished Latina sex workers' risk behavior with their clients remains poorly characterized. We investigated perceived health beliefs regarding susceptibility to/severity of HIV/AIDS, and sexual agency regarding barriers to condom use, benefits of unprotected sex, and risk-reduction behavior with clients among a sample of 33 brothel workers in Belize. Although 77% of participants felt at risk for HIV, only 30% always use condoms and 43% did not refuse unprotected sex with clients. Participants' narrative explanations for unprotected sex emphasized that clients'preferences often overrode brothel workers fear of HIV, and that the health benefits of using condoms with clients were often weighed against the social benefits of unprotected sex. Implications for brothel-based condom promotion programs and further research are discussed.
Asunto(s)
Actitud Frente a la Salud/etnología , Hispánicos o Latinos/etnología , Trabajo Sexual/etnología , Migrantes/psicología , Sexo Inseguro , Adolescente , Adulto , Belice , Condones/estadística & datos numéricos , Miedo/psicología , Femenino , Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Necesidades y Demandas de Servicios de Salud , Hispánicos o Latinos/educación , Humanos , Modelos Psicológicos , Narración , Investigación Metodológica en Enfermería , Pobreza/etnología , Conducta de Reducción del Riesgo , Asunción de Riesgos , Encuestas y Cuestionarios , Migrantes/educación , Sexo Inseguro/etnología , Sexo Inseguro/prevención & controlRESUMEN
Young people constitute a priority for sexual health research, policy and planning. Many studies, however, regard youth as a homogeneous group defined by developmental stages and their problems as inherent rather than factors resulting from structural vulnerability. Ethnographic data from this study provided strong evidence of the inappropriateness, in prevention interventions, of the concept of 'young people' as a group defined only by age and gender. When incorporating social resources and support into the analysis, specific segments of youth with diverse sexual practices and health seeking behaviours emerge. Thus, although most young people in urban areas show a similar level of HIV/STI knowledge, their exposure to risk varies according to their living conditions. Two population segments - "street guys" and "fast girls" - identified as vulnerable for sexual risk, are characterized. Both groups hang out on the streets, and most are involved in using alcohol and drugs, and/or practicing transactional sex. This study provided evidence for the need of various approaches according to level of poverty and social vulnerability in order to develop more effective HIV/AIDS and STI prevention programs to meet the needs of young men and women in low-income areas.