This survey of sexual practices in the United States has been combed by the media for items of interest to the public: monogamous sex is much more widespread in this country than has been thought; infidelity is less frequent than presumed; vaginal intercourse is the defining experience of heterosexual behavior; watching one's partner undress is stimulating to many people; married couples have more sex than single people (unmarried, cohabiting couples have the most sex of all); the majority of couples experience sex twice a week to several times a month; 2.8% of men identify themselves as homosexual and 1.4% of women do so, but a higher percentage of people consider a same-gender experience to have some appeal; 75% of men always experience orgasm compared with 28.6% of women, but more nearly equal numbers of men and women declare themselves satisfied with their sexual experiences. The book is, in fact, a

The Social Organization of Sexuality: Sexual Practices in the United States

Summary Background Female sex workers are a population who are at heightened risk of HIV infection secondary to biological, behavioural, and structural risk factors. However, three decades into the HIV pandemic, understanding of the burden of HIV among these women remains limited. We aimed to assess the burden of HIV in this population compared with that of other women of reproductive age. Methods We searched PubMed, Embase, Global Health, SCOPUS, PsycINFO, Sociological Abstracts, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, and POPLine for studies of female sex workers in low-income and middle-income countries published between Jan 1, 2007, and June 25, 2011. Studies of any design that measured the prevalence or incidence of HIV among female sex workers, even if sex workers were not the main focus of the study, were included. Meta-analyses were done with the Mantel-Haenszel method with a random-effects model characterising an odds ratio for the prevalence of HIV among female sex workers compared with that for all women of reproductive age. Findings Of 434 selected articles and surveillance reports, 102 were included in the analyses, representing 99 878 female sex workers in 50 countries. The overall HIV prevalence was 11·8% (95% CI 11·6–12·0) with a pooled odds ratio for HIV infection of 13·5 (95% CI 10·0–18·1) with wide intraregional ranges in the pooled HIV prevalence and odds ratios for HIV infection. In 26 countries with medium and high background HIV prevalence, 30·7% (95% CI 30·2–31·3; 8627 of 28 075) of sex workers were HIV-positive and the odds ratio for infection was 11·6 (95% CI 9·1–14·8). Interpretation Although data characterising HIV risk among female sex workers is scarce, the burden of disease is disproportionately high. These data suggest an urgent need to scale up access to quality HIV prevention programmes. Considerations of the legal and policy environments in which sex workers operate and actions to address the important role of stigma, discrimination, and violence targeting female sex workers is needed. Funding The World Bank, UN Population Fund.

https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(12)70066-X.pdf

Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(05)67732-X.pdf

Sex-work harm reduction

Men's influences on women's reproductive health: medical anthropological perspectives.

Herpes simplex virus type 2 (HSV-2) is a common infection in many countries, with prevalence in some regions, such as sub-Saharan Africa, higher than in the USA. Prevalence in adult general populations in sub-Saharan Africa ranges from 30% to 80% in women, and from 10% to 50% in men. Most data from Central and South America are from women, in whom HSV-2 prevalence ranges from about 20% to 40%. Prevalence in the general population in developing Asian countries appears to be lower (10-30%). In common with the developed world, HSV-2 seropositivity is uniformly higher in women than in men and increases with age. In general, HSV-2 seroprevalence is high in populations whose behaviour leads to a high risk of acquiring other sexually transmitted infections (STIs), such as STI clinic attendees and sex workers (SWs), with some African studies reporting greater than 80% HSV seropositivity in SWs. New infections are most common among young adults, a fact that should be considered when proposing and implementing measures to reduce HSV, and possibly HIV, transmission. Currently, comparison between studies is hampered by the lack of a validated type-specific serological assay that has a similar performance across a range of populations. HSV-2 is a major cause of genital ulcer disease (GUD) in the developing world. Genital herpes is a cause of morbidity and increases the risk of HIV acquisition, due to disruption of mucosal membranes. Where possible, the aetiology of GUD should be evaluated using polymerase chain reaction (PCR), while recognizing that co-pathogens can exist in a lesion. GUD management should incorporate HIV testing and antiherpetic treatment.

Epidemiology of herpes simplex virus type 2 infection in the developing world.

Behavioral risk factors for STD/HIV transmission in Bangladesh's trucking industry.

Objectives: This study characterises the prevalence of a broad spectrum of sexually transmitted diseases (STDs) (herpes simplex virus 2, syphilis, chlamydia, gonorrhoea), and examines associations between risk factors and infection in men working in Bangladesh9s trucking industry. Given the high risk sexual behaviours of truck drivers and helpers in many contexts, as well as the direct health effects of STDs and their role in facilitating HIV transmission, it is important to understand the prevalence of STDs and associated risk factors in this population. Methods: A cross sectional study was conducted at Tejgaon truck stand, one of the largest truck stands in Dhaka, the capital city. The study group, comprising 388 truck drivers and helpers, was selected via a two tiered sampling strategy. Of 185 trucking agencies based at the truck stand, 38 agencies were randomly selected, and a mean of 10 subjects (drivers/helpers) were recruited from each agency. Urine and blood samples were collected from subjects after an interview about their lifestyle and a comprehensive physical examination. Gold standard laboratory tests were conducted for the detection of STD. Multiple logistic regression was used to assess associations between infections and potential risk factors. Results: The levels of prevalence of disease were HSV-2 (25.8%), serological syphilis (5.7%), gonorrhoea (2.1%), chlamydia (0.8%). For infection with any bacterial STD (syphilis, gonorrhoea, or chlamydia) the only significant risk factor was having sex with a commercial sex worker in the past year (OR=3.54; CI=1.29–9.72). For HSV-2, truck helpers working primarily on interdistrict routes were significantly more likely to be infected than drivers working on these routes (OR=2.51, CI=1.13–5.55). Conclusions: The high prevalence of HSV-2, and to a lesser extent syphilis, and the low levels of condom use despite high numbers of casual sexual partners, illustrate the importance of promoting condom use, particularly in commercial sexual encounters, to men in Bangladesh9s trucking industry.

https://sti.bmj.com/content/sextrans/78/1/31.full.pdf

STD in Bangladesh's trucking industry: prevalence and risk factors

Background: Little is known about infection rates for human immunodeficiency virus (HIV) and other diseases that can be transmitted sexually in Bangladeshi women who may be at intermediate levels of risk—that is, women who are not commercial sex workers (CSWs) but whose sexual contacts may include men at high risk for STD. This study examines HIV/hepatitis/STD and other genital tract infections in women living near Tejgaon truck stand in Dhaka, Bangladesh. Methods: This population based study was conducted from January to December 1998. A random sample of 384 women provided urine and blood samples and participated in an interview; 261 of them also had a physical examination in which vaginal and cervical specimens were taken. Laboratory tests included PCR on urine and cervical swabs for gonorrhoea and chlamydia, culture for trichomoniasis, serology tests for syphilis, herpes simplex 2, hepatitis B, C, D, HIV1, HIV2, and clinical diagnoses of other genital tract infections. Results: None of the participants tested positive for HIV. In the 261 women who had a physical examination, trichomoniasis was detected in 19.5%, chlamydia in 3.4%, gonorrhoea in 5.4%, bacterial vaginosis in 37.2%, and candidiasis in 10%. In the full sample of 384 women, with tests of urine and blood, prevalence of infection with chlamydia, gonorrhoea, syphilis, and herpes simplex 2 was detected in 0%, 6.3%, 5.7%, and 32% respectively. Almost 50% of the subjects had ever been exposed to hepatitis B, 3.6% were currently infective, 1.6% had hepatitis C, and none had hepatitis D. Conclusion: The high prevalence of certain of these infectious diseases indicates the need to implement prevention interventions with these women and, perhaps more importantly, with their male partners. Qualitative research is needed to provide insights into their sexual behaviour and the contexts in which high risk behaviours occur.

https://sti.bmj.com/content/sextrans/77/5/344.full.pdf

Prevalence of infectious diseases in Bangladeshi women living adjacent to a truck stand: HIV/STD/hepatitis/genital tract infections.

HIV Prevention in Developing Countries: Tenets of Behavioral and Biomedical Approaches L Gibney The Global HIV/AIDS Pandemic: Trends and Patterns D Tarantola, et al Emerging Biomedical Interventions L Lawson, et al Intervening in Blood Supply and Use Systems: HIV Testing NT Constantine, et al The Evolution of Voluntary Testing and Counseling as an HIV Prevention Strategy SA Allen, et al Controlling Other Sexually Transmitted Diseases G Dallabetta, et al Behavioral Interventions KR O'Reilly, et al Insights for HIV Prevention from Industrialized Countries' Experience A Raj, et al The Use of Psychosocial Models for Guiding the Design and Implementation of HIV Prevention Interventions: Translating Theory into Practice GM Wingood, RJ DiClemente Interventions for Commercial Sex Workers and Their Clients EN Ngugi, et al Interventions for Adolescents P Aggleton, K Rivers Interventions for Workers Away from Their Families M Haour-Knipe, et al Interventions for Injecting Drug Users AS Abdul-Quader, et al Interventions for Men Who Have Sex with Men P Aggleton, et al HIV Prevention for the General Population PR Lamptey, GAW Goodridge Intervention Research for Future HIV Prevention: Design and Implementation Considerations L Gibner Index

Preventing HIV in developing countries : biomedical and behavioral approaches

Behavioural risk factors for HIV/AIDS in Bangladesh were reviewed in a preceding article in this journal. Omitted from that review was a discussion of potential biomedical risk factors including: (i) an unregulated blood supply system in which blood used in transfusions is not screened for HIV and is donated primarily by professional donors: (ii) unsterile injections in non-formal and formal health-care settings; and (iii) a high prevalence in high-risk groups of other sexually transmitted diseases (STDs) which may function as co-factors for HIV transmission, particularly if chronically untreated. Studies elsewhere in the world suggest that the unregulated blood supply system, in particular, poses a serious danger in terms of the spread of the HIV epidemic. While certain socio-cultural factors may be contributing to low levels of HIV in Bangladesh, the prevalence of biomedical and behavioural risk factors suggest the importance of implementing targeted cost-effective interventions now.

HIV / AIDS in Bangladesh: an assessment of biomedical risk factors for transmission.

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