RESUMO
BACKGROUND: Despite evidence that education and poverty act through distinct pathways to influence sexually transmitted infection (STI), few studies have examined the unique, independent associations of these socioeconomic vulnerabilities with sexual risk behaviors and STI among women. METHODS: From August to October 2013, women at an antenatal clinic in Gressier, Haiti, were interviewed and tested for chlamydial infection, gonorrhea, and trichomoniasis (N = 200). We measured low educational attainment as less than 9 years of schooling and currently living in poverty based on crowding, defined as more than 2 people sleeping in one room. We used logistic regression to estimate independent associations between each socioeconomic indicator and outcomes of sexual behaviors and STI. RESULTS: Approximately 29% of the sample had a current STI (chlamydia, 8.0%; gonorrhea, 3.0%; trichomoniasis, 20.5%), with 2.5% testing positive for more than 1 STI. Forty percent of the sample reported low educational attainment and 40% reported current poverty. Low educational attainment was associated with early risk behaviors, including twice the odds of earlier sexual debut (adjusted odds ratio [AOR], 2.09; 95% confidence interval [CI],: 1.14-3.84). Poverty was associated with reporting the current main sexual partner to be nonmonogamous (AOR, 2.01; 95% CI, 1.00-4.01) and current STI (AOR, 2.50; 95% CI, 1.26-4.98). CONCLUSIONS: Education and poverty seem to independently influence STI behaviors and infection, with low education associated with early sexual risk and poverty associated with current risk and infection. Improving women's educational attainment may be important in improving risk awareness, thereby reducing risky sexual behaviors and preventing a trajectory of STI risk.
Assuntos
Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Infecções Sexualmente Transmissíveis/epidemiologia , Tricomoníase/epidemiologia , Adolescente , Adulto , Instituições de Assistência Ambulatorial , Infecções por Chlamydia/prevenção & controle , Educação , Feminino , Gonorreia/prevenção & controle , Haiti/epidemiologia , Humanos , Modelos Logísticos , Pobreza , Gravidez , Assunção de Riscos , Comportamento Sexual , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/prevenção & controle , Fatores Socioeconômicos , Tricomoníase/prevenção & controleRESUMO
PURPOSE OF REVIEW: This review highlights the epidemiologic research on club drug use in the past year, with a focus on clinical epidemiology, social epidemiology, new methodological approaches, and alternative explanations for drug use behaviors. RECENT FINDINGS: Although 3,4-methylenedioxy-N-methylamphetamine (MDMA) or ecstasy is currently classified as a type of hallucinogen and its withdrawal is not recognized in the Diagnostic and Statistical Manual of Mental Disorders, there is evidence for the association of withdrawal symptoms with MDMA abstinence. Findings from latent class analysis indicate that MDMA users have a significantly higher risk of dependence than lysergic acid diethylamide users. Research on sociodemographic factors associated with club drug use continues to be a main focus worldwide. New epidemiologic research methods have been developed to enable researchers to monitor real-time drug use behaviors and to conduct surveys on sensitive issues in public places. In addition to traditional behavioral models, researchers began to examine the club drug phenomenon in the context of economic environment. SUMMARY: Recent findings on MDMA use further question the current drug classification in the diagnostic systems. Despite the continuous growth in the club drug research literature, there is no study on the influence of genetic factors on club drug use. More research in this area is needed.