RESUMO
Juan Navia died on September 4, 2010. Those who knew him as the director of the University of Alabama's John J. Sparkman Center for International Public Health Education and later the dean of UAB School of Public Health watched him train and shape the next generation of global public health leaders with a kind heart and a firm, but gentle, hand. On this third anniversary of Professor Navia's passing, in response to an invitation from the Journal of Dental Research to write an essay on an educator who influenced the professional trajectories of many people, we have put together an account of some of his contributions and attributes to highlight this remarkable leader's accomplishments in and impact on dental public health and global nutrition.
Assuntos
Odontologia em Saúde Pública/história , Alabama , Cuba , Cárie Dentária , Pesquisa em Odontologia/educação , Pesquisa em Odontologia/história , Educação em Odontologia/história , História do Século XX , História do Século XXI , Humanos , Ciências da Nutrição/educação , Ciências da Nutrição/história , Odontologia em Saúde Pública/educaçãoAssuntos
Infecções por HIV/prevenção & controle , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Síndrome da Imunodeficiência Adquirida/transmissão , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Jamaica/epidemiologia , Pediatria , Gravidez , Complicações Infecciosas na Gravidez/epidemiologiaRESUMO
We assessed the validity of a syndromic case management approach for reproductive tract infections (RTIs) among 371 pregnant women attending antenatal care facilities in Kingston, Jamaica, using an algorithm previously validated in high-risk Jamaican women. For our antenatal attenders, the algorithm had low sensitivities for all RTIs (66.7% for cervicitis, 35.4% for trichomoniasis, 11.1% for bacterial vaginosis (BV) and 24% for candidiasis). Specificities for BV (88.9%) and candidiasis (81.1%) were higher than for cervicitis (62.8%) and trichomoniasis (68.5%). The positive predictive values were lower than 36% for all diagnoses, especially BV (6.9%). Syndromic management of RTIs in pregnant women was problematic using a clinical algorithm that had worked well for high-risk women. Syndromic management for RTIs in Jamaican antenatal clinics is only a temporary solution until more simple and affordable diagnostic tests for RTIs are developed and/or until laboratory support and clinical care can be upgraded at antenatal clinics.
Assuntos
Algoritmos , Complicações Infecciosas na Gravidez/diagnóstico , Doenças Vaginais/diagnóstico , Adolescente , Adulto , Instituições de Assistência Ambulatorial , Feminino , Humanos , Jamaica , Valor Preditivo dos Testes , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Cuidado Pré-Natal , Sensibilidade e Especificidade , Cervicite Uterina/diagnóstico , Doenças Vaginais/microbiologiaRESUMO
BACKGROUND: In Iquitos, Peru, motorcycle taxis are a common form of public transportation used both by residents and visitors. GOAL: To evaluate the prevalence of factors associated with sexually transmitted disease risk and of Neisseria gonorrhoeae and Chlamydia trachomatis infections among motorcycle taxi drivers working in Iquitos, Peru. STUDY DESIGN: A convenience sample of motorcycle taxi drivers was recruited through street outreach. Participants were confidentially interviewed and provided urine specimens for gonococcal and chlamydial infection testing. RESULTS: A history of sexually transmitted disease (62%) or symptoms in the past year (35%) and of referral of clients to commercial sex workers (60%) was common. The prevalence of gonococcal or chlamydial infection was 3.5%. CONCLUSIONS: Motorcycle taxi drivers are a major means of public transportation in Iquitos, Peru, have high personal risks for sexually transmitted disease, and interface often with at-risk persons.
Assuntos
Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Veículos Automotores , Infecções Sexualmente Transmissíveis/epidemiologia , Adolescente , Adulto , Infecções por Chlamydia/prevenção & controle , Gonorreia/prevenção & controle , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Peru/epidemiologia , Prevalência , Trabalho Sexual , Infecções Sexualmente Transmissíveis/prevenção & controle , Urina/microbiologiaRESUMO
Trichomoniasis, bacterial vaginosis (BV) and candidiasis are reproductive tract infections (RTIs) of the vagina. We conducted a cross-sectional study in 4 prenatal clinics in Kingston, Jamaica, to estimate the prevalence of these infections and the risk factors that may facilitate their transmission among pregnant women. Of the 269 women studied, 18.0% had culture-positive trichomoniasis, 44.1% had BV (Nugent score > or = 7) and 30.7% were positive for candidiasis by wet mount. A multiple logistic regression analysis showed that having a malodorous discharge was associated with trichomoniasis (odd ratios [OR]=3.9, confidence intervals [CI]=1.04-14.7) and BV (OR=3.4, CI=1.3-8.7). Women who took action to prevent HIV infection had lower BV prevalence (OR=0.34, CI=0.12-0.98). Women who were employed were less likely to have any of the infections (OR=0.61, CI=0.36-1.03). The strong association of a symptomatic presentation with trichomoniasis and BV suggests the merit of considering syndromic management of vaginitis in this population.
Assuntos
Candidíase Vulvovaginal/epidemiologia , Candidíase Vulvovaginal/etiologia , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/etiologia , Vaginite por Trichomonas/epidemiologia , Vaginite por Trichomonas/etiologia , Vaginose Bacteriana/epidemiologia , Vaginose Bacteriana/etiologia , Adolescente , Adulto , Análise de Variância , Candidíase Vulvovaginal/prevenção & controle , Candidíase Vulvovaginal/transmissão , Estudos Transversais , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Jamaica/epidemiologia , Modelos Logísticos , Vigilância da População , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Prevalência , Fatores de Risco , Vaginite por Trichomonas/prevenção & controle , Vaginite por Trichomonas/transmissão , Saúde da População Urbana/estatística & dados numéricos , Vaginose Bacteriana/prevenção & controle , Vaginose Bacteriana/transmissãoRESUMO
BACKGROUND: Iquitos Peru, a densely populated port city housing both a large military base and a booming tourist industry, provides a thriving market for commercial sex and, consequently, sexually transmitted disease (STD). The purpose of this study was to characterize the prevalence of gonococcal and chlamydial infections among commercial sex workers (CSWs) and to correlate those findings with social/behavioral characteristics. METHODS: One hundred CSWs, recruited through street and brothel outreach, were administered questionnaires. Urine specimens were collected for gonorrhea and chlamydia testing using ligase chain reaction assays. RESULTS: Twenty-eight percent of CSWs were positive for chlamydia (22%) or gonorrhea (14%). Registered CSWs were more likely to have worked more than 5 years (p = 0.03), report 10 or more partners (p = 0.002), and work in brothels (p < 0.001). Significant associations were also noted between infection status and age, with adolescents at increased risk (odds ratio [OR] = 4.13, p = 0.001), and duration of employment, with those employed less than 5 years at increased risk (OR = 3.72, p = 0.04). The latter association, however, was because of age. Also, most CSWs believed themselves to be at no/small risk or didn't know their risk of future gonococcal infection (30%/12% and 25%, respectively) and AIDS (25%/8% and 35%, respectively), with 11% perceiving AIDS as more of a threat. CONCLUSIONS: High infection rates, lack of knowledge regarding STD/HIV risk assessment, and other high-risk behavior prevalent among this population stress the need for STD intervention. The study further suggests that educational/risk assessment programs and risk reduction interventions could be successful.
PIP: This study aims to characterize the prevalence of gonococcal and chlamydial infections among commercial sex workers (CSWs) in Iquitos, Peru, which provides a thriving market for CSWs and, consequently, sexually transmitted diseases (STDs) and to correlate those findings with social/behavioral characteristics. About 100 CSWs, recruited through street (n = 37) and brothel outreach (n = 67), were interviewed through questionnaires. Urine specimens were collected for gonorrhea and chlamydial testing. Findings revealed that registered CSWs were significantly more likely to have worked in the sex trade for more than 5 years, report 10 or more sex partners per week, and to work in brothels. Nonetheless, there were no significant differences in age, average charge for sex, or STD prevalence between registered and unregistered CSWs. Overall, 28% of CSWs were positive for chlamydia (22%) and gonorrhea (14%). Furthermore, a number of CSWs stated that they did not know whether they were at risk or assessed their risk as being low for contracting gonorrhea or AIDS. There was no significant association between self-perception of STD risk and STD prevalence. High infection rates, lack of knowledge regarding HIV/AIDS and STD risk assessment, and other high-risk behaviors prevalent among this population stress the need for STD intervention programs and risk reduction behavior.
Assuntos
Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Trabalho Sexual/estatística & dados numéricos , Adolescente , Adulto , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis/isolamento & purificação , Preservativos , Feminino , Humanos , Neisseria gonorrhoeae/isolamento & purificação , Razão de Chances , Peru/epidemiologia , Projetos Piloto , Prevalência , Medição de Risco , Urina/microbiologiaRESUMO
Of 970 sexually transmitted disease (STD) patients enrolled at the Comprehensive Health Centre, Kingston, Jamaica, between November 1990 and January 1991, 710 (73%, 333 men and 377 women) were reexamined between January 1992 and July 1993 to estimate the incidence of HIV and HTLV-I infection and to identify risk factors for infection. Of those reexamined, 20% were recruited passively when they returned to the clinic of their own accord, and 80% were recruited actively through field visits to their homes. Passively recruited persons were significantly more likely than active recruits to have had a sexually transmitted disease since enrollment or at their follow-up visit. Seven men and one woman became HIV positive during the period of follow-up. The overall HIV incidence rate was 0.7 per 100 person years (95% confidence interval [CI] = 0.3 to 1.4), 1.4 (CI = 0.6 to 2.8) for men and 0.2 (CI = 0.004 to 0.9) for women. Four of 270 men and 4 of 318 women were HTLV-I positive, an overall incidence of 0.9 per 100 person years (CI = 0.4 to 1.7), 1.0 for men and 0.8 for women. HTLV-I infection was associated with an age of 30 years or older (p < 0.01). The presumed lower transmission probability for HTLV-I may combine with a higher prevalence of HTLV-I in sexual partners to produce similar overall incidence rates for the two infections. The HIV and HTLV-I incidence rates may have been underestimated, because the study subjects who did not return to the clinic may have had a somewhat higher risk. On univariate analysis, there were significant associations between HIV infection in men and drinking alcohol before sex, cocaine use, total number of sex partners, sex with a prostitute since enrollment, ever accepting money for sex, the average number of sex partners per month, bruising during sex, and genital ulcers found on follow-up examination. This analysis needs to be interpreted with caution in view of the small number of seroconverters, which did not allow testing for independent effects in a logistic regression model.
Assuntos
Infecções por HIV/epidemiologia , HIV , Infecções por HTLV-I/epidemiologia , Vírus Linfotrópico T Tipo 1 Humano , Ambulatório Hospitalar , Adulto , Western Blotting , Ensaio de Imunoadsorção Enzimática , Feminino , HIV/imunologia , Anticorpos Anti-HIV/análise , Infecções por HIV/diagnóstico , Infecções por HIV/transmissão , Anticorpos Anti-HTLV-I/análise , Infecções por HTLV-I/diagnóstico , Infecções por HTLV-I/transmissão , Vírus Linfotrópico T Tipo 1 Humano/imunologia , Humanos , Incidência , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Fatores de RiscoRESUMO
Of 970 sexually transmitted disease (STD) patients enrolled at the Comprehensive Health Centre, Kingston, Jamaica, between November 1990 and January 1991, 710 (73 percent, 333 men and 377 women) were reexamined between January 1992 and July 1993 to estimated the incidence of HIV and HTLV-1 infection and to identify risk factors for infection. Of those reexamined, 20 percent were recruited passively when they returned to the clinic of their own accord, and 80 percent were recruited actively through field visits to their homes. Passively recruited persons were significantly more likely than active recruits to have had a sexually transmitted disease since enrollment or at their follow-up visit. Seven men and one women became HIV positive during the period of follow-up. The overall HIV incidence rate was 0.7 per 100 person years (95 percent confidence interval [CI] = 0.3 to 1.4 (CI = 0.6 to 2.8) for men and 0.2 (CI = 0.004 to 0.9) for women. Four of 270 men and 4 of 318 women were HTLV-1 positive, and overall incidence of 0.9 per 100 person years (CI = 0.4 to 1.7), 1.0 for men and 0.8 for women. HTLV-1 infection was associated with an age of 30 years or older (p < 0.01). The presumed lower transmission probability for HTV-1 may combine with a higher prevalence of HTLV-1 in sexual partners to produce similar overall incidence rates for the two infections. The HIV and HTLV-1 incidence rates may have been underestimated, because the study subjects who did not return to the clinic may have had a somewhat higher risk. On univariate analysis, there were significant associations between HIV infection in men and drinking alcohol before sex, cocaine use, total number of sex partners, sex with a prostitute since enrollment, ever accepting money for sex, the average number of sex partner per month, bruising during sex, and genital ulcers found on follow-up examination. This analysis needs to be interpreted with caution in view of the small number of seroconverters, which did not allow testing for independent effects in a logistic regression model(AU)
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vírus Linfotrópico T Tipo 1 Humano , HIV/imunologia , Infecções por HIV/epidemiologia , Infecções por HTLV-I/epidemiologia , Ambulatório Hospitalar , Western Blotting , Ensaio de Imunoadsorção Enzimática , Anticorpos Anti-HIV/análise , Infecções por HIV/diagnóstico , Infecções por HIV/transmissão , Anticorpos Anti-HTLV-I/análise , Infecções por HTLV-I/diagnóstico , Infecções por HTLV-I/transmissão , Incidência , Jamaica/epidemiologia , Admissão do Paciente , Fatores de RiscoRESUMO
Of 970 sexually transmitted disease (STD) patients enrolled at the Comprehensive Health Centre, Kingston, in January 1991, 710 (73 percent, 333 men and 377 women) were re-examined between January 1992 and July 1993 in order to estimate the incidence of HIV and HTLV-I infection and to identify risk factors for transmission. Of those re-examined, 20 percent were recruited passively when they returned to the clinic of their own accord, and 80 percent were recruited actively through field visits to their homes. Passively recruited persons were significantly more likely than active recruits to have had a STD since enrolment or at their follow-up visit. Seven men and one woman became HIV-positive during the period of follow-up. The overall HIV incidence rate was 0.7 per 100 person years (CI 0.3-1.4); or for men 1.4 (CI 0.5-2.8) and for women 0.2 (CI0.004-0.9). Four of 270 men and four of 318 women were HTLV-I-positive, an overall incidence of 0.9 per 100 person years (CI 0.4-1.7); 1.0 for men and 0.8 for women. The presumed lower transmission probability for HTLV-I may combine with a higher prevalence of HTLV-I in sexual partners to produce similar overall incidence rates for the two infections. The HIV and HTLV-I incidence rates may have been underestimated because some of the study subjects who were not included may have had a somewhat higher risk. On univariate analysis there were significant associations between HIV transmission in men and drinking alcohol before sex, cocaine use, total number of sex partners and sex with a prostitute since enrollment and ever accepting money for sex, the average number of sex partners per month, bruising during sex and genital ulcers on follow-up examination. This analysis needs to be intepreted with caution in view of the small number of seroconverters which did not allow testing for independent effects in a logistic regression model (AU)
Assuntos
Feminino , Humanos , Masculino , Infecções por HIV/epidemiologia , Infecções por HTLV-I/epidemiologia , Jamaica/epidemiologia , Fatores de RiscoRESUMO
Human T-cell lymphotropic virus type 1 (HTLV-I) status was assessed in 994 patients attending a sexually transmitted disease (STD) clinic in Kingston, Jamaica, between November 1990 and January 1991 for a new STD complaint. Of 515 heterosexual men, 36 (7.0%) were HTLV-I seropositive, as were 38 (7.9%) of 479 women. HTLV-I seroprevalence increased with age in women. A history of blood transfusion was associated with HTLV-I in both sexes, significantly so in men [odds ratio (OR) 4.7, confidence interval (CI) 1.1-17 for men; OR 1.9, CI 0.6-5.0 for women]. Further analysis excluded all persons reporting a transfusion. On multiple logistic regression analysis, independent associations with HTLV-I infection in men were shown for marital status (OR 3.5, CI 1.2-10 for married/common law vs. single/visiting unions), agricultural occupation (OR 9.0, CI 2.0-41), bruising during sex (OR 2.9, CI 1.0-8.1), > or = 15 years at first sexual intercourse (OR 2.9, CI 1.0-8.2), and a positive test for hepatitis B surface antigen (OR 7.3, CI 1.2-52). In women, associations were shown for two or more sex partners in the 4 weeks prior to complaint (OR 4.9, CI 1.8-13), 11 or more lifetime sexual partners (OR 5.9, CI 1.3-27), aged < 15 years at first sexual intercourse (OR 2.3, 1.0-5.4), bruising during sex (OR 2.7, CI 1.1-6.6), microhaemagglutination-Treponema pallidum positivity (OR 3.6, CI 1.6-8.4), and human immunodeficiency virus infection (OR 14, CI 2.1-92).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Infecções por HTLV-I/epidemiologia , Comportamento Sexual , Infecções Sexualmente Transmissíveis/epidemiologia , Adulto , Fatores Etários , Transfusão de Sangue , Estudos Transversais , Feminino , Anticorpos Anti-HTLV-I/sangue , Humanos , Jamaica/epidemiologia , Masculino , Estado Civil , Prevalência , Análise de Regressão , Fatores de RiscoRESUMO
Human T-cell lymphotropic virus type 1 (HTLV-I) status was assessed in 994 patients attending a sexually transmitted disease (STD) clinic in Kingston, Jamaica, between November 1990 and January 1991 for a new STD complaint. Of 515 heterosexual men, 36 (7.0 percent) were HTLV-I seropositive, as were 38 (7.9 percent) of 479 women. HTLV-I seroprevalence increased with age in women. A history of blood transfusion was associated with HTLV-I in both sexes, significantly so in men [odds ratio (OR) 4.7, confidence interval (CI) 1.1-17 for men; OR 1.9, CI 0.6-5.0 for women]. Further analysis excluded all persons reporting a transfusion. On multiple logistic regression analysis, independent associations with HTLV-I infection in men were shown for marital status (OR 3.5, CI 1.2-10 for married/common law vs. single/visiting unions), agricultural occupation (OR 9.0, CI 2.0-41), bruising during sex (OR 2.9, CI 1.0-8.1), o 15 years at first sexual intercouse (OR 2.9, CI 1.0-8.2), and a positive test for hepatitis B surface antigen (OR 7.3, CI 1.2-52). In women, associations were shown for two or more sex partners in the 4 weeks prior to complaint (OR 4.9, CI 1.8-13), 11 or more lifetime sexual partners (OR 5.9, CI 1.3-27), aged < 15 years at first sexual intercouse (OR 2.3, 1.0-5.4), bruising during sex (OR 2.7, CI 1.1-6.6), microhaemagglutination-Treponema pallidum positivity (OR 3.6, CI 1.6-8.4), human immunodeficiency virus infection (OR 14, CI 2.1-92). STDs and bruising during sex may facilitate sexual transmission of HTLV-I, whereas sexual activity is a more important risk factor in women than men. Programs promoting safer sexual practices and controlling STDs may reduce HTLV-I infection in Jamaica (AU)
Assuntos
Adulto , Feminino , Humanos , Masculino , Infecções por HTLV-I/epidemiologia , Comportamento Sexual , Infecções Sexualmente Transmissíveis/epidemiologia , Fatores Etários , Transfusão de Sangue , Estudos Transversais , Anticorpos Anti-HTLV-I/sangue , Estado Civil , Prevalência , Análise de Regressão , Fatores de Risco , Jamaica/epidemiologiaRESUMO
Two cross-sectional surveys were undertaken to estimate the prevalence of genital ulcer disease (GUD) in all clients presenting at the Comprehensive Health Centre in Kingston, Jamaica with a new STD complaint. The first survey done in 1983 involved 23,050 clients (men 11,948; women 11,102). The second survey in 1990 involved 1,001 clients (men 517; women 484). All clients were screened for syphilis and in 1990 for HIV. Culture for herpes virus was done on a subsample of 103 persons seen in 1983, but in the main, diagnoses were clinical. In 1983, GUD was found in 1,571 clients, an overall prevalence of 6.8 percent (men 1,110, 9.3 percent; women 461, 4.2 percent). Of those with GUD, genital herpes was diagnosed in 267 (17 percent); syphilis in 203 (12.9 percent); chancroid in 195 (12.4 percent); viral warts in 89 (5.7 percent); lymphogranuloma venereum in 65 (4.1 percent) and granuloma inguinale in 55 (3.6 percent). A diagnosis could not be made in 697 (44.5 percent) cases. All conditions were significantly higher in men (p<0.001) except for syphilis which was higher in women (p<0.05) and viral warts, where there was no significant difference. In 1990, GUD was found in 128 clients, an overall prevalence of 12.8 percent (men 95, 18.2 percent; women 33, 6.8 percent). Of clients with GUD, syphilis was diagnosed in 24 (18.8 percent); chancroid in 17 (13.3 percent); genital herpes in 10 (7.8 percent); viral warts in 8 (6.3 percent); lymphogranuloma venereum in 5 (3.9 percent) and granuloma inguinale in 3 (2.3 percent). A diagnosis could not be made in 61/128, 47.6 percent of cases in 1990. The prevalence of HIV was 28/1,001 (3.2 percent). A significant association was found between GUD and HIV infection (men with current GUD: OR 7.3, CI1.4 - 72; women with history of "bad blood" (syphilis): OR 6.6, CI 1.3-30). Overall prevalence rates of GUD were significantly higher in 1990 than in 1983 for both sexes (p<0.001), as well as total rates for each sex (males p< 0.001, females p<0.004) (AU)
Assuntos
Estudo Comparativo , Humanos , Masculino , Feminino , Genitália/patologia , Úlcera/classificação , Infecções Sexualmente Transmissíveis/epidemiologia , Inquéritos Epidemiológicos , Condiloma Acuminado/epidemiologia , Herpes Genital , Infecções por HIV , Jamaica/epidemiologiaRESUMO
BACKGROUND AND OBJECTIVES: Human papillomavirus is the major etiologic agent of cervical cancer. Although the incidence of cancer of the cervix is high in Jamaica, the prevalence of human papillomavirus among Jamaican women has not been defined. GOAL OF THE STUDY: To estimate the prevalence of human papillomavirus infection and associated risk factors in women attending an STD clinic in Kingston, Jamaica. STUDY DESIGN: A cross-sectional survey was done of 202 women attending an STD clinic in Kingston in 1990. Cervical and vaginal cells were collected by lavage, and human papillomavirus genomes were detected in extracted DNA using low-stringency Southern blot hybridization. RESULTS: Fifty-eight (28.7%) women were identified as HPV positive. Prevalence of HPV by age group was 39% in women 15-19 years old, 33% of women 20-24 years old, 31% in women 25-29 years old, and 17% in those 30 years or older. Increasing age was significantly associated with a lower prevalence of human papillomavirus infection (test for trend, P = 0.025). The effect of age was independent of years of sexual activity. Women reporting more than one sexual partner per month on average were found to have a significantly higher HPV prevalence (odds ratio 2.87, 95% confidence Interval 1.29-6.38), as were women who reported more frequent sex (test for trend, P = 0.006). CONCLUSIONS: Sexual behavior is associated with risk of human papillomavirus infection. The decrease of human papillomavirus prevalence in older women agrees with other studies that argue in favor of a biological effect, such as increased immunity to human papillomavirus with age. A better understanding of why immunity to human papillomavirus may develop in older women may provide the basis for developing an effective vaccine to prevent cancer of the cervix.
PIP: During November 1990-January 1991, DNA was extracted from cervicovaginal cells from 202 women attending the Comprehensive Health Centre, a sexually transmitted disease (STD) clinic, in Kingston, Jamaica, to determine the prevalence of human papilloma virus (HPV). Health workers interviewed these women so researchers could identify risk factors for HPV. 58 women (28.7%) tested positive for HPV. 62% had uncharacterized HPV DNA types. 16% had more than one type of HPV. HPV prevalence fell with age (39% for 15-19 year olds, 33% for 20-24 year olds, 31% for 25-29 year olds and 17% for 30+ year olds; odds ratio [OR] for oldest group = 0.34; p = 0.025), suggesting that older women have developed an immunity to HPV infection. The higher the number of years of sexual activity, the lower the HPV prevalence (40% for 1-4 years, 32% for 5-9 years, and 23% for 10+ years; OR for 10+ years was 0.44; p = 0.03). Women with at least two sexual partners over the last 12 months had a higher HPV prevalence than those with fewer sexual partners (OR = 2.87; p = 0.01). The greater the average number of times women claimed to have had vaginal intercourse per month in the last year, the greater the HPV prevalence (OR for 3-4 times = 2.07, OR for 5+ times = 3.22; p = 0.006). A multiple logistic regression analysis revealed that age confounded the inverse association between HPV prevalence and years of sexual activity. 3% of Pap smears exhibited cervical dysplasia. Further studies are needed to obtain a better understanding of why immunity to HPV may occur in older women. This information could form the basis for developing an effective vaccine against cervical cancer.
Assuntos
Infecções por Papillomavirus/epidemiologia , Doenças Virais Sexualmente Transmissíveis/epidemiologia , Infecções Tumorais por Vírus/epidemiologia , Adolescente , Adulto , Fatores Etários , Colo do Útero/virologia , Estudos Transversais , DNA Viral/análise , Feminino , Humanos , Jamaica/epidemiologia , Papillomaviridae/genética , Papillomaviridae/isolamento & purificação , Prevalência , Fatores de Risco , Comportamento Sexual , Doenças Virais Sexualmente Transmissíveis/virologia , Vagina/virologiaRESUMO
The prevalence of human papilloma virus (HPV) was investigated in 202 Jamaican women attending a health clinic for sexually transmitted diseases in 1990. Cervicovaginal cells were collected by lavage, and HPV genomes were detected in extracted DNA using low-stringency Southern Blot hybridization. Fifty-eight (28.7 percent) women were identified as HPV-positive. Prevalence of HPV by age group was 39 percent in women aged 15-19 years, 33 percent in women 20-24 years, 31 percent in women 25-29 years and 17 percent in those aged 30 years or over. Increasing age was significantly associated with a lower prevalence of HPV infection (test for trend p = 0.025). The effect of age was independent of years of sexual activity. Women reporting more than one sexual partner per month on average were found to have a significantly higher HPV prevalence (Odds Ratio 2.75, 95 percent Confidence interval 1.24 - 6.12) as were women who reported more frequent sex (test for trend p=0.006). Sexual behaviour is clearly associated with risk of HPV infection. Moreover, the decrease of HPV prevalence in older women is in agreement with other studies that argue in favour of a biological effect such as increased immunity with age. This study is important in identifying high-risk women in Jamaica, where the incidence of cervical cancer is high (AU)
Assuntos
Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Papillomavirus Humano/isolamento & purificação , Neoplasias do Colo do Útero/epidemiologia , Fatores de RiscoRESUMO
Between November 1990 and January 1991, status of human immunodeficiency virus (HIV) infection was assessed for 522 men and 484 women attending the Comprehensive Health Centre in Kingston, Jamaica, for a new sexually transmitted disease (STD) complaint. Prevalence of HIV type 1 (HIV-1) infection was 3.1% (31 of 1,006), a tenfold rise in seroprevalence in 4.5 years. Nineteen of 517 (3.7%) heterosexual men, 3 of 5 (60%) homosexual/bisexual men, and 9 of 484 (1.9%) women were infected with HIV. In heterosexual men, factors associated with HIV infection after age adjustment included present complaint of genital ulcer [odds ratio (OR) 7.3; 95% confidence interval (CI) 1.4-72], past history of genital ulcer (OR, 4.3; CI, 1.4-12), positive MHATP syphilis serology (OR, 3.4; CI, 1.1-10), sex with a prostitute in the past month (OR, 3.8; CI, 1.1-11). Three or more sex partners in the month prior to complaint (OR, 3.6; CI, 1.0-12), and bruising during sex (OR, 4.0; CI, 1.4-13). On multiple logistic regression analysis, independent associations with HIV infection were shown for bruising during sex (OR, 3.0; CI, 1.1-8.3), positive MHATP syphilis serology (OR, 3.2; CI, 1.1-9.5), and history of genital ulcer (OR, 2.9; CI, 1.0-8.0).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Doenças dos Genitais Femininos/complicações , Doenças dos Genitais Masculinos/complicações , Genitália/lesões , Infecções por HIV/epidemiologia , HIV-1 , Adulto , Fatores Etários , Intervalos de Confiança , Estudos Transversais , Feminino , Infecções por HIV/etiologia , Humanos , Jamaica/epidemiologia , Masculino , Razão de Chances , Prevalência , Análise de Regressão , Fatores de Risco , Comportamento Sexual , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/complicações , ÚlceraRESUMO
Between November 1990 and January 1991, status of human immunodeficiency virus (HIV) infection was assessed for 522 men and 484 women attending the Comprehensive Health Centre in Kingston, Jamaica, for a new sexually transmitted disease (STD) complaint. Prevalence of HIV type 1 (HIV-1) infection was 3.1 percent (31 of 1,006), a tenfold rise in seroprevalence in 4.5 years. Nineteen of 517 (3.7 percent) heterosexual men, 3 of 5 (60 percent) homosexual/bisexual men, and 9 of 484 (1.9 percent) women were infected with HIV. In heterosexual men, factors associated with HIV infection after age adjustment included present complaints of genital ulcers [odds ratio (OR) 7.3; 95 percent confidence interval (CI) 1.4-72], past history of genital ulcer (OR)4.3; CI, 1.4-12), positive MHATP syphilis serology (OR, 3.4; CI, 1.1-10), sex with a prostitute in the past month (OR, 3.8; CI, 1.1-11). Three or more sex partners in the month prior to the complaint (OR, 3.6; CI, 1.0-12), and bruising during sex (OR, 4.0; CI, 1.4-13). On multiple logistic regression analysis, independent associations with HIV infection were shown for bruising during sex (OR, 3.0; CI, 1.1-8.3), positive MHATP syphilis serology (OR,3.2; CI, 1.1-9.5), and history of genital ulcer (OR 2.9; CI, 1.0-8.0). (AU)
Assuntos
Humanos , Adulto , Masculino , Feminino , HIV-1 , Infecções por HIV/epidemiologia , Doenças dos Genitais Femininos/complicações , Doenças dos Genitais Masculinos/complicações , Genitália/lesões , Estudos Transversais , Infecções por HIV/etiologia , Jamaica/epidemiologia , Fatores de Risco , Comportamento Sexual , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/complicações , ÚlceraRESUMO
We performed a second examination for human papillomavirus (HPV) DNA on 51 sexually experienced 13- to 21-year-old (mean = 17.8 years) female patients seen at an urban teaching hospital. Cervicovaginal lavages were performed 6 to 36 months apart (median = 13.3 months) to collect cells for HPV DNA detection and typing by Southern blot hybridization. At the first and second visits, 39.2% (20/51) and 25.5% (13/51) of patients, respectively, were infected with HPV. Collectively, 56.9% (29/51) of patients had at least one positive HPV test result. Although 7.8% (4/51) were infected with HPV at both visits, only one patient had infection with the same HPV type. These findings suggest that although HPV infection is a common sexually transmitted disease, genotype-specific HPV infection detected by Southern blot at two visits was rare.
Assuntos
Colo do Útero/microbiologia , Papillomaviridae/isolamento & purificação , Infecções Tumorais por Vírus/microbiologia , Vagina/microbiologia , Adolescente , Adulto , Southern Blotting , Feminino , Seguimentos , Humanos , Incidência , New York/epidemiologia , Papillomaviridae/classificação , Comportamento Sexual , Infecções Tumorais por Vírus/epidemiologiaRESUMO
AIDS surveillance data from the Dominican Republic are described for 1983-89. A positive serologic test for HIV was required, and standard clinical criteria were used for defining AIDS. There were 1,202 AIDS cases (820 men, 372 women, 10 of unknown gender) reported to the Ministry of Health, for a cumulative case rate of 17 per 100,000 persons. Rapid growth of the epidemic is noted, with 43% of the total cases reported in 1989. Heterosexual exposure accounts for 53% (593) of all cases, with a male-to-female ratio of 2.2:1, resembling a World Health Organization Pattern I/II country. Prevalence is highest in and surrounding the urbanized tourist areas of Santo Domingo and Puerto Plata and in districts with a high concentration of sugar plantation barracks, where laborers from Haiti and the Dominican Republic work and live. The distribution of AIDS cases is described by transmission exposure category, age, sex, year of diagnosis, and district. The National AIDS Surveillance Program can be improved by validation of exposure transmission categories through selected case investigation and by better reporting through training of health care providers. Surveillance data will assist in targeting future public health efforts to regions and persons at highest risk.
Assuntos
Síndrome da Imunodeficiência Adquirida/epidemiologia , Soroprevalência de HIV , Comportamento Sexual , Síndrome da Imunodeficiência Adquirida/transmissão , Adolescente , Adulto , Fatores Etários , Criança , República Dominicana/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores SexuaisRESUMO
Analysis of AIDS mortality data for New York City for 1981-1987 reveals that Puerto Ricans represent the racial/ethnic group most severely affected by this city's AIDS epidemic. Cumulative age-adjusted AIDS mortality rates among Puerto Rico-born males are significantly higher (362 per 100,000) than among blacks (267), whites (182), or other Hispanic (217) males, and cumulative age-specific mortality rates for males are highest for the Puerto Rico-born in every adult age group. AIDS proportional mortality analysis indicates that in 1987 the proportion of all deaths due to AIDS was 10% among those Puerto Rican-born, 12% among other Hispanics (which includes at least 50% United States-born Puerto Ricans), 6% among blacks, and 2% among whites.