Sexual Behaviour and HPV Infections in 18 to 29 Year Old Women in the Pre-Vaccine Era in the Netherlands

Contains fulltext : 71058.pdf ( ) (Open Access)BACKGROUND: Infection with Human Papillomavirus (HPV) is a necessary event in the multi-step process of cervical carcinogenesis. Little is known about the natural history of HPV infection among unscreened young adults. As prophylactic vaccines are being developed to prevent specifically HPV 16 and 18 infections, shifts in prevalence in the post vaccine era may be expected. This study provides a unique opportunity to gather baseline data before changes by nationwide vaccination occur. METHODS AND PRINCIPAL FINDINGS: This cross-sectional study is part of a large prospective epidemiologic study performed among 2065 unscreened women aged 18 to 29 years. Women returned a self-collected cervico-vaginal specimen and filled out a questionnaire. All HPV DNA-positive samples (by SPF(10) DEIA) were genotyped using the INNO-LiPA HPV genotyping assay. HPV point prevalence in this sample was 19%. Low and high risk HPV prevalence was 9.1% and 11.8%, respectively. A single HPV-type was detected in 14.9% of all women, while multiple types were found in 4.1%. HPV-types 16 (2.8%) and 18 (1.4%) were found concomitantly in only 3 women (0.1%). There was an increase in HPV prevalence till 22 years. Multivariate analysis showed that number of lifetime sexual partners was the most powerful predictor of HPV positivity, followed by type of relationship, frequency of sexual contact, age, and number of sexual partners over the past 6 months. CONCLUSIONS AND SIGNIFICANCE: This study shows that factors independently associated with HPV prevalence are mainly related to sexual behaviour. Combination of these results with the relative low prevalence of HPV 16 and/or 18 may be promising for expanding the future target group for catch up vaccination. Furthermore, these results provide a basis for research on possible future shifts in HPV genotype prevalence, and enable a better estimate of the effect of HPV 16-18 vaccination on cervical cancer incidence

The Intersection of Social Stress, Mental Well-Being, and Sexual Health Among Black Women in Emerging Adulthood

With an estimated 37,000 new HIV infections each year, HIV continues to be a major public health concern. HIV affects some populations more than others. Young Black women, in particular, are disproportionately affected by HIV. While being a woman does not typically increase a person’s HIV risk, being Black and being a woman does. Data indicate that individual-level factors do not fully address the differences in HIV and STIs between Black emerging adult women and their White counterparts. Thus, it is critical to better understand contextual factors such as social stress and mental-wellbeing which might better account for these disparities. To that end, the current study sought to answer the following questions: 1) Do depressive symptoms mediate the relationship between social stress (as measured by financial strain, perceived discrimination, and perceived neighborhood disorder) and sexual risk (as measured by condom use and number of partners)? 2) Does hope moderate the mediated relationship between social stress and sexual risk behaviors? Path analysis was used to examine the relationship between social stress, depressive symptomology, hope, and sexual risk among Black women during emerging adulthood. Results showed discrimination significantly predicted depressive symptoms, whereas financial strain and perceived neighborhood disorder did not. Depressive symptoms significantly predicted condom use and number of partners. Depressive symptoms mediated the relationship between social stress and sexual risk behaviors. Consequently, hope did not moderate the relationship between social risk behaviors, depressive symptoms, and sexual risk behaviors. Clinicians caring for Black women in emerging adulthood should be aware of the systemic, interpersonal, and cultural factors that contribute to the mental health of clients. Cultural competence training and education is imperative for anyone who engages with this population regularly including clinicians, university staff, administrators, and professors. Interventions and treatment should focus on healthy coping methods and education surrounding mental and sexual health

Cultural adaptation of the fertility status awareness tool to low and middle income countries (Sudan) using survey, systematic review and meta-analysis and interview methodologies

Globally, fertility problems have severe negative consequences. In Low and Middle Income Countries (LMIC) like Sudan women especially bear the burden of the inability to achieve pregnancy and childlessness. The severity of these consequences coupled with the lack of fertility knowledge motivated the need to enhance fertility awareness in LMIC. Recently several fertility awareness tools have been developed. One such tool is the Fertility Status Awareness Tool (FertiSTAT), a short, one page self-administered tool that provides information about the signs, symptoms and preventable causes of fertility problems. This tool provides personalized risk knowledge that allows women to make informed decisions about their fertility. The FertiSTAT was developed and validated in the UK but it has utility as a cost-effective tool to enhance fertility awareness in LMIC where this simple tool could be embedded in existing (but resource limited) reproductive health services. The aim of the studies presented in this thesis was to culturally adapt the FertiSTAT to ensure that it was comprehensive in its coverage of risks and it is acceptable and feasible for use in Sudan. The potential new risk factors for inclusion in FertiSTAT were identified through literature search, expert consultations and survey. The risk factors were subjected to systematic review and meta-analysis. Results of the studies indicated that cultural adaptation would require cultural targeting to be inclusive of new risk factors relevant to Sudan and other LMIC and be linguistically and graphically culturally appropriate. The risk factors found to be associated with fertility problems were genital tuberculosis, HIV, bacterial vaginosis, female genital mutilation and consanguinity. Results of stakeholder meetings and patient interviews lead to recommendations about changes to language and presentation of materials to enhance acceptability and feasibility of FertiSTAT. These recommendations included the need for adding provider-administered versions of the FertiSTAT to enable cultural tailoring of information to each user’s level of literacy and cultural attributes. An integration of all knowledge acquired from these studies lead to two adapted versions of the FertiSTAT, a flipchart and a checklist. It is anticipated that these tools can be used to enhance fertility awareness in Sudan. The studies can also be used as an adaptation protocol such that the procedural knowledge gained from adaptation in Sudan can be transferred to other LMIC. Such undertakings can potentially help improve individual and, in time, societal awareness of fertility problems with the eventual aim to prevent fertility problems, alleviate individual suffering for the most vulnerable and aid in the global efforts to promote sexual and reproductive health equity where it is most needed